- Among breast cancer patients:
- It is estimated that 2% to 6%:
- Carry a BRCA1 / BRCA 2 mutation
- It is estimated that 2% to 6%:
- Among epithelial ovarian cancer patients:
- It is estimated that 10% to 15%:
- Carry a BRCA1 / BRCA 2 mutation
- It is estimated that 10% to 15%:
- The lifetime risk of breast cancer for BRCA1 / BRCA2 mutation carriers:
- Is approximately 45% to 80%
- The lifetime ovarian cancer risk is:
- 45% to 60% for BRCA1 mutation carriers
- 11% to 35% for BRCA2 mutation carriers
- BRCA1 mutation carriers:
- Tend to be diagnosed with ovarian cancer at a younger age:
- Than BRCA2 mutation carriers or sporadic cases
- Tend to be diagnosed with ovarian cancer at a younger age:
- BRCA-linked ovarian cancers:
- Are associated with improved survival and longer disease-free interval:
- Compared to patients with sporadic ovarian cancer
- Are associated with improved survival and longer disease-free interval:
- To date, there is no reliable screening method to detect early ovarian cancer:
- The prognosis of advanced ovarian cancer:
- Is poor
- The prognosis of advanced ovarian cancer:
- Risk-reducing bilateral salpingo-oophorectomy (RRSO):
- Is associated with an 80% relative risk reduction:
- For the development of ovarian and fallopian tube cancers
- BSO causes a decrease in estrogen production:
- Which is thought to lead to a 50% risk reduction in the development of future breast cancer:
- Particularly among BRCA2 mutation carriers
- Which is thought to lead to a 50% risk reduction in the development of future breast cancer:
- Is associated with an 80% relative risk reduction:
- National Comprehensive Cancer Network (NCCN) guidelines recommend:
- That BRCA1 mutation carriers be offered RRSO between the ages of 35 and 40
- BRCA2 mutation carriers are recommended to undergo RRSO between the ages of 40 and 45
- A recent meta-analysis, which included three prospective studies of BRCA patients undergoing RRSO:
- Found that this procedure salpingo-oophorectomy was associated with a decreased ovarian cancer risk, and decreased all-cause mortality:
- With the largest risk reduction seen among BRCA1 mutation carriers
- RRSO is associated with premature menopause, osteoporosis, cardiovascular disease, in addition to other medical issues which can impact quality of life:
- Patients wishing to undergo RRSO should be counseled regarding these risks
- Found that this procedure salpingo-oophorectomy was associated with a decreased ovarian cancer risk, and decreased all-cause mortality:
- References:
- Bougie O, Weberpals JI. Clinical Considerations of BRCA1- and BRCA2-mutation carriers: a review. Int J Surg Oncol. 2011;2011:374012.
- National Comprehensive Cancer Network. Genetic/familial high risk assessment: breast and ovarian, Version 1.2020 https://www.nccn.org/professionals/physician_gls/pdf/genetics_bop.pdf Accessed February 23, 2023.
- Domchek SM, Friebel TM, Singer CF, Evans DG, Lynch HT, Isaacs C, et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA. 2010;304(9):967-975.
- Kauff ND, Domchek SM, Friebel TM, Robson ME, Lee J, Garber JE, et al. Risk-reducing salpingo-oophorectomy for the prevention of BRCA1- and BRCA2-associated breast and gynecologic cancer: a multicenter, prospective study. J Clin Oncol. 2008;26(8):1331-1337.
- Finch AP, Lubinski J, Moller P, Singer CF, Karlan B, Senter L, et al. Impact of oophorectomy on cancer incidence and mortality in women with a BRCA1 or BRCA2 mutation. J Clin Oncol. 2014;32(15):1547-1553.
- Marchetti C, De Felice F, Palaia I, Perniola G, Musella A, Musio D, et al. Risk-reducing salpingo-oophorectomy: a meta-analysis on impact on ovarian cancer risk and all cause mortality in BRCA 1 and BRCA 2 mutation carriers. BMC Womens Health. 2014;14:150.
Rodrigo Arrangoiz MS, MD, FACS, FSSO 