abstract: Peritoneal washing cytology in patients with BRCA1 or BRCA2 mutations undergoing risk-reducing salpingo-oophorectomies: A 10-year experience and reappraisal of its clinical utility

Peritoneal washing cytology in patients with BRCA1 or BRCA2 mutations undergoing risk-reducing salpingo-oophorectomies: A 10-year experience and reappraisal of its clinical utility



Peritoneal washing cytology in patients with BRCA1 or BRCA2 mutations undergoing risk-reducing salpingo-oophorectomies: A 10-year experience and reappraisal of its clinical utility.

Abstract

OBJECTIVE:

To evaluate the utility of peritoneal washing cytology (PWC) for detecting occult primary peritoneal carcinoma in patients with BRCA1 or BRCA2 mutations, we reviewed PWCs obtained during risk-reducing salpingo-oophorectomy (RRSO) from 117 patients at our institution and correlated the results with surgical pathology findings.........

open access - pdf: Risk-Reducing Bilateral Salpingo-Oophorectomy and Sexual Health: A Qualitative Study

Abstract
Objective: To examine the impact of risk-reducing bilateral salpingo-oophorectomy (RRBSO) on sexual function in BRCA gene
mutation carriers, compared with the effect on women undergoing
BSO (bilateral salpingo-oophorectomy) for benign indications from
a qualitative perspective.

Methods: 
Our study included 25 women who had undergone either
a RRBSO because of BRCA carrier status or a BSO for a benign
gynaecologic indication. Women were invited to participate if they
were at least six months post-BSO. They took part in an individual,
private interview during which they were asked open-ended
questions about their sexual health in the context of undergoing
BSO......

Long-term outcomes of BRCA1/BRCA2 testing: risk reduction and surveillance (risk reducing surgery - breasts/bilateral salpino-oophorectomies)

Abstract

BACKGROUND:

For BRCA1/BRCA2 gene testing to benefit public health, mutation carriers must initiate appropriate risk management strategies. There has been little research examining the long-term use and prospective predictors of the full range of risk management behaviors among women who have undergone BRCA1/2 testing. We evaluated long-term uptake and predictors of risk-reducing mastectomy (RRM), risk-reducing bilateral salpingo-oophorectomy (RRBSO), chemoprevention, and cancer screening among women at a mean of 5.3 years after testing.

METHODS:

The study participants comprised 465 women who underwent BRCA1/2 testing. Prior to genetic counseling, we measured family/personal cancer history, sociodemographics, perceived risk, cancer-specific distress, and general distress. We contacted patients at a mean of 5.3 years after testing to measure use of RRM, RRBSO, chemoprevention, and breast and ovarian cancer screening.

RESULTS:

Among participants with intact breasts and/or ovaries at the time of testing, BRCA1/2 carriers were significantly more likely to obtain RRM (37%) and RRBSO (65%) compared with women who received uninformative (RRM, 6.8%; RRBSO, 13.3%) or negative (RRM, 0%; RRBSO, 1.9%) results. Among carriers, precounseling anxiety was associated with subsequent uptake of RRM. RRO was predicted by age. Carriers were also more likely have used breast cancer chemoprevention and have undergone magnetic resonance imaging screening.

CONCLUSION:

This prospective evaluation of the uptake and predictors of long-term management outcomes provides a clearer picture of decision making in this population. At a mean of 5.3 years after testing, more than 80% of carriers had obtained RRM, RRBSO, or both, suggesting that BRCA1/2 testing is likely to have a favorable effect on breast and ovarian cancer outcomes.

abstract: Risk-reducing bilateral salpingo-oophorectomy and sexual health: a qualitative study

Conclusion:
This study provided a nuanced view of sexual health in women following RRBSO that was not captured by self-report questionnaires. Women with preoperative knowledge of post-BSO sexual side effects report being more prepared for surgery, and experience less sexual distress following their BSO.

open access: Australasian - Adequacy of risk-reducing gynaecologic surgery in BRCA1 or BRCA2 mutation carriers and other women at high risk of pelvic serous cancer

Blogger's Note: see Table 2 for the types of surgery and professional designation of who performed the surgery

"All women who had a hysterectomy had adequate surgery"

"Australasian BRCA1 and BRCA2 mutation carriers and women at high familial risk of “ovarian” cancer who elect RRSO must receive high quality care that will reduce their risk of gynaecological cancer. This study highlights the need for standardised surgical techniques and tissue processing protocols for RRSO. Clinicians who discuss RRSO with these women should consider referring them to specialist gynaecologic oncologists for their surgery, or at least should discuss the specifics of optimal surgery and pathology with the woman’s existing gynaecologist or general surgeon if he/she is planning to undertake the surgery. High risk women themselves should be educated about the likely pathogenesis of pelvic serous cancers from the fallopian tubes rather than the ovaries and hence the type of surgery that is optimal. Using the term “ovarian cancer” to describe this disease is misleading and arguably should be abandoned to reflect the emerging evidence regarding the  pathogenesis of this disease."

Most women carrying cancer genes (BRCA 1/2) take action: study | Reuters

Adequacy of risk-reducing gynaecologic surgery in BRCA1 or BRCA2 mutation carriers and other women at high risk of pelvic serous cancer

"...Four serous ovarian cancers and one endometrioid endometrial cancer were detected during surgery or pathological examination.
In conclusion Australasian women attending a specialist gynaecologic oncologist for RRGS (risk reducing gynaecologic surgery) are most likely to have adequate surgery and pathological examination.
Additional education of clinicians and consumers is needed to ensure optimal surgery and pathology in these women."

Does bilateral salpingectomy with ovarian retention warrant consideration as a temporary bridge to risk-reducing bilateral oophorectomy in BRCA1/2 mutation carriers? abstract

New Strategies in Ovarian Cancer: Uptake and experience of women at high risk of ovarian cancer who are considering risk-reducing salpingo-oophorectomy

Abstract

This paper reviews factors associated with uptake of risk-reducing salpingo-oophorectomy by women at increased hereditary risk for ovarian cancer, as well as quality of life issues following surgery. Forty one research studies identified through PubMed and PsychInfo met inclusion criteria. Older age, having had children, a family history of ovarian cancer, a personal history of breast cancer, prophylactic mastectomy, and BRCA1/2 mutation carrier status increase the likelihood of undergoing surgery. Psychosocial variables predictive of surgery uptake include greater perceived risk of ovarian cancer and cancer-related anxiety. Most women report satisfaction with their decision to undergo surgery and both lower perceived ovarian cancer risk and less cancer-related anxiety as benefits. Hormonal deprivation is the main disadvantage reported, particularly by premenopausal women who are not on hormonal replacement therapy (HRT). The evidence is mixed regarding satisfaction with the level of information provided prior to surgery, although generally women report receiving insufficient information regarding the pros and cons of HRT. These findings indicate that when designing decision aids, demographic, medical history, and psychosocial variables need to be addressed in order to facilitate quality decision making.

full free access: Women's Constructions of the 'Right Time' to Consider Decisions about Risk-Reducing Mastectomy and Risk-Reducing Oophorectomy (B.C.)

Methods (abstract): 

In-depth interviews were conducted with 22 BRCA1/2 carrier women and analyzed using qualitative, constant comparative methods. 

pdf file (free access):

A women-centred approach addresses issues beyond traditional
medical interventions, placing health in its broad social context, and also addresses barriers to access and respects women’s diversity [55]. Although risk-reducing surgery decisions are women’s decisions, women should not be saddled with the burden of tackling barriers to accessing health care services.
Health care professionals, health care organizations, and government must work hard to resolve these challenges.

 

abstract: Does bilateral salpingectomy with ovarian retention warrant consideration as a temporary bridge to risk-reducing bilateral oophorectomy in BRCA1/2 mutation carriers?

Occult ovarian cancers identified at risk-reducing salpingo-oophorectomy in a prospective cohort of BRCA1/2 mutation carriers.

"An unacceptably high proportion of pathologic examinations did not adequately examine ovaries and fallopian tubes obtained at RRSO."