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The JAMA Network
Comment & Response (to Narod)
November 10, 2016
Reservations About Risk-Reducing Salpingo-oophorectomy Without Hysterectomy in Women With BRCA Mutations—Reply
In Reply We appreciate the interest Dr
Narod has shown in our recent report examining the incidence of uterine
cancer after risk-reducing salpingo-oophorectomy without hysterectomy in
women with mutations in BRCA1 and BRCA2. While he
expresses concern that the multicenter collaboration to address this
specific question was initiated in 2014, he is mistaken in his
interpretation that the data were not prospectively ascertained or that
the initial design of the cooperating studies did not include plans for
assessment of our primary end points. As was outlined in the Methods,
the analysis was performed by pooling data from 3 ongoing prospective
cohort studies—2 single-institution studies conducted at Memorial Sloan
Kettering Cancer Center and the Abramson Cancer Center at University of
Pennsylvania and 1 multicenter study, the Prevention and Observation of
Surgical Endpoints (PROSE Consortium) study.1- 3
While there are some differences in the design of the individual
studies, a primary end point of all 3 studies has been to evaluate the
impact of various risk reduction strategies on cancer incidence in
individuals with BRCA mutations. Furthermore, to both harmonize
the analytic approach across the 3 cohorts and include only strictly
prospective data in the analysis, participant follow-up was included
only after the latest of study ascertainment, receipt of BRCA testing results, or risk-reducing salpingo-oophorectomy.
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