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JAMA Oncology
Editorial
CLARIFYING THE RISK OF UTERINE CANCER IN WOMEN WITH BRCA MUTATIONS
ASSESSING MORBIDITY AND/OR MORTALITY ASSOCIATED WITH MINIMALLY INVASIVE HYSTERECTOMY
MITIGATING RISK OF BREAST CANCER WITH COMBINATION HORMONE THERAPY
CONCLUSION
Although the study by Kauff et al1 suffers from a small number of cases, it does add to the literature linking the presence of a BRCA mutation, in particular BRCA1
mutations, with a small but not null risk of endometrial cancer. Of
concern is many of these uterine cancers are of serous histology, which
is known to harbor worse outcomes even when diagnosed with early-stage
disease. Perhaps it is time to consider that the line for risk-reducing
gynecologic surgery in patients with BRCA mutations not stop at
the ovaries and fallopian tubes. Thus, concomitant hysterectomy with
RRSO, when performed with a minimally invasive surgical approach,
particularly for women with a BRCA1 mutation, should be able to
be performed with minimum morbidity and allow for use of estrogen only
hormone therapy after surgery, if needed. For other women (those with a BRCA2
mutation, those who would require an open laparotomy to perform
hysterectomy, or those who may not require or desire hormone therapy),
it may be prudent to draw the line at RRSO. Further studies are required
to evaluate the true cost-effectiveness of concomitant hysterectomy
with RRSO and to explore the role of risk-reducing hysterectomy in women
with BRCA mutations who have already had RRSO. At the present time we would recommend that all women with a BRCA1/2
mutation undergoing RRSO should be made aware of the potential risks
and benefits of a concurrent hysterectomy and of the limitations in the
available studies on this issue prior to making an individualized
decision.
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