abstract
OBJECTIVE:
To estimate BRCA1/2 mutation carriers' cumulative ovarian cancer
risks after risk-reducing salpingectomy at various ages with delayed
oophorectomy several years later compared with risk-reducing
salpingo-oophorectomy.
METHODS:
A literature search was performed on cumulative ovarian cancer
risks and effects of risk-reducing salpingo-oophorectomy and
salpingectomy. Results were used in a modeling study to estimate
cumulative ovarian cancer
risks for various scenarios of salpingectomy with delayed oophorectomy
and risk-reducing salpingo-oophorectomy using Cox proportional hazard
models.
RESULTS:
Estimated cumulative ovarian cancer
risks at age 70 years for risk-reducing salpingectomy with delayed
oophorectomy are highest for BRCA1 mutation carriers undergoing
surgeries at higher age. Maximum increase in point estimates (from 1.8%
to 4.1%) occurs in 40-year-old BRCA1 mutation carriers undergoing
oophorectomy at age 45 years after nonprotective salpingectomy instead
of salpingo-oophorectomy at age 40 years. In the best-case scenario,
assuming 65% risk reduction by salpingectomy and 96% by
salpingo-oophorectomy, point estimates increase (from 1.8% to 2.6%) or
decrease (from 3.4% to 3.3%) depending on age. In the worst-case
scenario for BRCA2, point estimates maximally increase from 0.6% to 1.8%
in 45-year-old carriers when oophorectomy is performed at age 50 years
instead of risk-reducing salpingo-oophorectomy at age 45 years. In the
best-case scenario, point estimates increase (from 1.3% to 1.5%) or
decrease (from 1.5 to 1.3%).
CONCLUSION:
Differences in estimated ovarian cancer
risks between risk-reducing salpingo-oophorectomy and salpingectomy
with delayed oophorectomy are small, even if salpingectomy is
ineffective. Presented estimated ovarian cancer
risks can be used in counseling BRCA1/2 mutation carriers, thereby
facilitating a personalized and well-informed choice for either
strategy.
0 comments :
Post a Comment
Your comments?
Note: Only a member of this blog may post a comment.