(3 items) Risk-Reducing Surgery in Hereditary Breast/Ovarian Cancer

NEJM
June 16, 2016 

To the Editor:

A point of contention that I have with the article by Hartmann and Lindor (Feb. 4 issue)1 has to do with the role of hysterectomy at the time of bilateral risk-reducing salpingo-oophorectomy. The use of tamoxifen for chemoprevention is not a justification to proceed with a concurrent hysterectomy. Better alternatives — aromatase inhibitors such as exemestane, for instance — have now proved to be effective for risk reduction in postmenopausal women, including those who have had their ovaries removed, and do not increase the risk of endometrial cancer. Similarly, the use of combination hormone therapy with continuous estrogen and progesterone has not been associated with an increased risk of endometrial cancer; in fact, some studies suggest the contrary.2,3 The hysterectomy itself adds substantial risk to a relatively low-risk procedure and cannot be justified without a survival advantage and certainly not by the supposed advantage of hormonal therapy.4

 

1.	Risk-Reducing Surgery in Hereditary Breast and Ovarian Cancer.
	MacInnis RJ, Pike MC, Hopper JL.
	N Engl J Med. 2016 Jun 16;374(24):2403-2404.
	PMID: 27305206 [PubMed - as supplied by publisher]

2.	Risk-Reducing Surgery in Hereditary Breast and Ovarian Cancer.
	Karam A.
	N Engl J Med. 2016 Jun 16;374(24):2403-2404.
	PMID: 27305205 [PubMed - as supplied by publisher]

3.	Risk-Reducing Surgery in Hereditary Breast and Ovarian Cancer.
	[No authors listed]
	N Engl J Med. 2016 Jun 16;374(24):2403-2404.
	PMID: 27305204 [PubMed - as supplied by publisher]