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Prophylactic Oophorectomy

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81. Diagnostic accuracy, clinical effectiveness and budget impact of screening BRCA1/2 mutation carriers by MRI

of these mutations have a high life-time risk of developing breast or ovarian cancer. Current strategies for early detection and risk reduction of breast cancer are screening using mammography and/or magnetic resonance imaging (MRI), prophylactic mastectomy and oophorectomy. While Norwegian national clinical guidelines describe prophylactic mastectomy as the best option to reduce breast cancer risk, many women in Norway prefer to have annual breast cancer screening using both mammography and MRI. It is important

2018 Norwegian Institute of Public Health

84. Opportunistic Salpingectomy and Other Methods of Risk Reduction for Ovarian/Fallopian Tube/Peritoneal Cancer in the General Population

not been identified on the epithelial surface of the ovary (High). 3. The recent change to the International Federation of Gynecology and Obstetrics staging system for high-grade serous cancers in 2014 included ovary, fallopian tube, and primary peritoneum together as primary sites of disease, reflecting the difficulty in distinguishing the location in which the cancer developed (High). 4. Prophylactic bilateral salpingo-oophorectomy can reduce the risk of high-grade serous cancers by 80% to 90 (...) % for breast cancer mutation carriers (High). 5. In women with breast cancer mutations, 5% to 6% of fallopian tubes from prophylactic salpingo-oophorectomies have serous tubal intraepithelial carcinomas present (High). 6. Serous tubal intraepithelial carcinomas are found most commonly at the fimbriated end of the fallopian tube and have p53 mutation changes identical to associated cancers (High). 7. Clear cell and endometrioid carcinomas are now believed to originate from endometriotic lesions deposited

2017 Society of Obstetricians and Gynaecologists of Canada

85. Opportunistic Salpingectomy and Other Methods of Risk Reduction for Ovarian/Fallopian Tube/Peritoneal Cancer in the General Population

not been identified on the epithelial surface of the ovary (High). 3. The recent change to the International Federation of Gynecology and Obstetrics staging system for high-grade serous cancers in 2014 included ovary, fallopian tube, and primary peritoneum together as primary sites of disease, reflecting the difficulty in distinguishing the location in which the cancer developed (High). 4. Prophylactic bilateral salpingo-oophorectomy can reduce the risk of high-grade serous cancers by 80% to 90 (...) % for breast cancer mutation carriers (High). 5. In women with breast cancer mutations, 5% to 6% of fallopian tubes from prophylactic salpingo-oophorectomies have serous tubal intraepithelial carcinomas present (High). 6. Serous tubal intraepithelial carcinomas are found most commonly at the fimbriated end of the fallopian tube and have p53 mutation changes identical to associated cancers (High). 7. Clear cell and endometrioid carcinomas are now believed to originate from endometriotic lesions deposited

2017 Society of Obstetricians and Gynaecologists of Canada

86. ESMO–ESGO Consensus Conference Recommendations on Ovarian Cancer: Pathology and Molecular Biology, Early and Advanced Stages, Borderline Tumours and Recurrent Disease

. Recommendation 1.1: a large majority of extrauterine HGSCs arise in the fallopian tube from STIC. SEE-FIM sectioning of both fallopian tubes should be carried out in all cases of extra- uterine HGSC where the tubes are grossly normal, and also in risk-reducing prophylactic surgery specimens. Level of evidence: III Strength of recommendation: A Consensus: 100% (40) yes, 0% (0) no, 0% (0) abstain (40 voters) Recommendation1.2: extrauterine HGSC can only be assigned as ovarian in origin if both fallopian tubes (...) (cancer and bor- derline ovarian tumour)? Fertility-sparing surgery (FSS) is based on unilateral salpingo- oophorectomy and complete surgical staging. This management seems to be safe in patients with conventional low-grade stage IA (serous, endometrioid or mucinous expansile subtype) [95–97]. The use of FSS in patients with stage IC disease should be de?ned using the current 2014 FIGO staging system [98]. FSS is accept- able for stage IC1 tumours, with half of these recurrences being isolated

2019 European Society for Medical Oncology

87. Hereditary Gastrointestinal Cancers: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

-oophorectomy reduce the incidence of EC and ovarian cancer in the LS population, although the survival benefit has not been demonstrated [29]. We recommend an annual gynaecological examination, TV US with cancer antigen 125 (CA 125) analysis and endometrial biopsy from age 30–35 years [IV, C]. Prophylactic hysterectomy with bilateral oophorectomy is an option that might be discussed and considered for mutation carriers who have completed childbearing or are postmenopausal [IV, C]. Urinary tract (...) ultrasound (EUS) surveillance in individuals with LS and one first-degree relative (FDR) affected with PC may be considered, although more supporting evidence is needed [IV, C] [28]. Gynaecological surveillance Transvaginal ultrasound (TV US) has shown poor sensitivity and specificity for the diagnosis of EC in women with LS, while endometrial sampling could identify patients with premalignant endometrial lesions or asymptomatic endometrial carcinomas. Prophylactic hysterectomy and/or bilateral salpingo

2019 European Society for Medical Oncology

88. Guidelines for the Evaluation and Treatment of Perimenopausal Depression

of recommendations. The preliminary guidelines were presented at the 2016 NAMS Annual Meeting and the 2017 World Congress on Women’s Mental Health, and feedback from those presentations was incorporated into final vetting of the guidelines, including the addition of a section on Specific Populations to address issues related to depression, hysterectomy with or without oophorectomy and primary ovarian insufficiency. The literature (English only) in each section was reviewed in a systematic manner for publications (...) . Additionally, the following two sections were added following feedback from NAMS, 4) Is hysterec- tomy with and without oophorectomy a risk factor for depres- sive symptoms/disorders? And 5) Is Premature Ovarian Insufficiency (POI) linked to depression? The section on the presentation of depression addressed: 1) Is there a unique or characteristic clinical presentation of depressive disorders during the menopause transition? 2) How is depression diagnosed during the menopause transition? What

2018 The North American Menopause Society

89. Guideline on the Diagnosis, Treatment, and Follow-up of Patients with Endometrial Cancer

IQWIG. Positronenemissionstomographie (PET) und PET/CT bei Ovari- alkarzinom.2011.www.iqwiq.de 22 Torizuka T et al. Ovarian cancer recurrence: role of whole-body posi- tron emission tomography using 2-[fluorine-18]-fluoro-2-deoxy-D- glucose.EurJNuclMedMolImaging2002;29:797–803 23 Takekuma M et al. Positron emission tomography with 18F-fluoro-2- deoxyglucose for the detection of recurrent ovarian cancer. Int J Clin Oncol2005;10:177–181 24 Rebbeck TR et al. Prophylactic oophorectomy in carriers (...) . Effect of short-term hormone replacement therapy on breast cancer risk reduction after bilateral prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers: thePROSEStudyGroup.JClinOncol2005;23:7804–7810 29 Madalinska JB et al. The impact of hormone replacement therapy on menopausalsymptomsinyoungerhigh-riskwomenafterprophylactic salpingo-oophorectomy.JClinOncol2006;24:3576–3582 30 ParkerWHetal.Ovarianconservationatthetimeofhysterectomyand long

2018 German Guideline Program in Oncology

90. Guideline on the Diagnosis, Treatment, and Follow-up of Patients with Endometrial Cancer

Qualitätsförderung und Forschung im Gesundheitswesen GmbH 5-ASA 5-aminosalicylic acid (mesalazine) ASCO American Society of Clinical Oncology AUC area under the curve AWMF Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (Working Group of Scientific Medical Specialist Societies) BMI body mass index BSO bilateral salpingo-oophorectomy CI confidence interval(s) CT computed tomography DEGAM Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (German Society for General Medicine

2018 German Guideline Program in Oncology

92. Endometrial Hyperplasia, Management of

and Gynaecologists 3 of 30 RCOG/BSGE Green-top Guideline No. 67 A A B A B C D D C C P PPostmenopausal women requiring surgical management for endometrial hyperplasia without atypia should be offered a bilateral salpingo-oophorectomy together with the total hysterectomy. For premenopausal women, the decision to remove the ovaries should be individualised; however, bilateral salpingectomy should be considered as this may reduce the risk of a future ovarian malignancy. A laparoscopic approach to total hysterectomy (...) -oophorectomy together with the total hysterectomy. For premenopausal women, the decision to remove the ovaries should be individualised; however, bilateral salpingectomy should be considered as this may reduce the risk of a future ovarian malignancy. Endometrial ablation is not recommended because complete and persistent endometrial destruction cannot be ensured and intrauterine adhesion formation may preclude endometrial histological surveillance. How should women with atypical hyperplasia who wish

2016 Royal College of Obstetricians and Gynaecologists

93. Ovarian Cancer Screening

tubes (fimbria), as initially suggested by histologic evaluation of specimens from BRCA mutation carriers who have undergone prophylactic salpingo-oophorectomy [3,5,6,8]. The average lifetime risk for developing ovarian cancer for a woman in the United States is approximately 1.3% [2]. Women with certain risk factors are known to be at increased risk, including presence of BRCA1 or BRCA2 mutations, strong family history (ie, first-degree relative, particularly if premenopausal at the time (...) . Daniilidis A, Karagiannis V. Epithelial ovarian cancer. Risk factors, screening and the role of prophylactic oophorectomy. Hippokratia. 2007;11(2):63-66. 15. Reade CJ, Riva JJ, Busse JW, Goldsmith CH, Elit L. Risks and benefits of screening asymptomatic women for ovarian cancer: a systematic review and meta-analysis. Gynecol Oncol. 2013;130(3):674-681. ACR Appropriateness Criteria ® 11 Ovarian Cancer Screening 16. Jacobs IJ, Skates SJ, MacDonald N, et al. Screening for ovarian cancer: a pilot randomised

2017 American College of Radiology

94. Clinical Practice Guidelines for the Surgical Treatment of Patients With Lynch Syndrome

that prophylactic surgery at age 40 years is the optimal strategy. 28 h owever, there are major limitations in the assumptions made, and the decision about the proper strategy must also take into account other factors than cost-effectiveness, most nota- bly patient preference. n o clear specific age recommenda- tion can be made based on the evidence. Because of the clear benefit of prophylactic surgery independent of col- ectomy, it is reasonable to offer hysterectomy and bilateral salpingo-oophorectomy to all (...) colectomy is preferred for cancer risk reduction. Strong recommendation based on moderate- quality evidence. 1B in contrast to sporadic colon cancer, 3 issues must be evalu- ated when considering the appropriate surgical treatment for colon cancer in the setting of l ynch syndrome: 1) appro- priate treatment of the primary tumor, 2) consideration of risk reduction with prophylactic removal of nonneoplastic colon, and 3) morbidity and quality of life after colectomy. t here is no prospective randomized

2017 American Society of Colon and Rectal Surgeons

95. Clinical Practice Guidelines for the Treatment of Colon Cancer

. Oophorectomy is recommended for grossly abnormal ovaries or contiguous extension of the colon cancer, but routine prophylactic oophorectomy is not neces- sary. Grade of Recommendation: Strong recommen- dation based on low-quality evidence, 1C. In women with colon cancer who have normal ovaries and have average risk for ovarian cancer, prophylactic oopho- rectomy is not recommended. Alternatively, prophylactic oophorectomy should be considered when there are other risk factors for ovarian pathology (...) such as HNPCC or BRCA and in postmenopausal woman. The ovaries are the site for colorectal cancer metastasis (Krukenberg tumor) in 3% to 8% of patients. 149 Oophorectomy is recommended in pa- tients with suspected or confirmed ovarian metastasis, ei- ther by direct extension or metastasis. If 1 ovary is involved with metastatic disease, a bilateral oophorectomy should be performed with the expectation of prolonged survival in af- fected women who receive adjuvant chemotherapy. 149,150 3. The treatment

2017 American Society of Colon and Rectal Surgeons

96. Practice Bulletin: Hereditary Breast and Ovarian Cancer Syndrome

and BRCA2 mutation carriers undergoing prophylactic risk-reducing salpingo-oophorectomy (92–95). This is more common in women older than 45 years than in younger women. Thorough pathology review of the ovaries and the fallopian tubes is critical in order to detect microscopic cancer in these high-risk women. Rather than taking only one or two representative sections from each ovary, the complete ovaries and fallopian tubes should be seri- ally sectioned and evaluated (91). In fact, more cases (...) of microscopic fallopian tube cancer have been detected than microscopic ovarian cancer in the prophylactic risk- reducing salpingo-oophorectomy specimens of BRCA1 and BRCA2 mutation carriers. Although the tumors identified are microscopic, they are often high grade, and information from the peritoneal lavage may reflect the aggressiveness of the disease (96). Because occult cancer may be found only through serial sectioning and thorough evaluation of the ovaries and tubes, it is pos- sible that some

2017 Society of Gynecologic Oncology

97. Interventions to Address Sexual Problems in People With Cancer

to hormonal therapy among men), this can lead to nonadherence or even discontinuation of cancer therapy. Providing information about and, as needed, relief from these (eg, pain medication for use with aromatase inhibitors) can improve sexual function. In general, improved symptom management leads to improved sexual response. Patients at high risk of cancer who choose to undergo cancer risk–reducing surgeries, such as bilateral mastectomy and/or oophorectomy, may also experience an effect on sexual (...) functioning. Clinicians should be aware that while the target population of this guideline is people with cancer, the management strategies and support for patients undergoing prophylactic surgery should remain the same as outlined in this guideline. Overall Sexual Functioning and Satisfaction for Women Recommendation The Expert Panel noted that current recommendations did not address the important role of symptom management and its effect on the sexual response. Improved symptom management can

2017 American Society of Clinical Oncology Guidelines

98. Hormone Therapy in Primary Ovarian Insufficiency

reduction after bilateral prophylactic oophorectomy in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group. J Clin Oncol 2005;23:7804–10. [ ] [ ] Malone KE, Daling JR, Weiss NS. Oral contraceptives in relation to breast cancer. Epidemiol Rev 1993;15:80–97. [ ] Romieu I, Berlin JA, Colditz G. Oral contraceptives and breast cancer. Review and meta-analysis. Cancer 1990;66:2253–63. [ ] [ ] Thomas DB. Oral contraceptives and breast cancer: review of the epidemiologic literature. Contraception 1991;43 (...) , demonstrating a 20–30% increased risk of the disease in these postmenopausal HT users ( , ), these data are not generalizable to women with primary ovarian insufficiency. Women with primary ovarian insufficiency are much younger at the time of HT initiation and their baseline risk of breast cancer is significantly lower compared with women to whom HT is administered after natural menopause. Short-term exposure to HT in BRCA1 and BRCA2 carriers following risk-reducing bilateral salpingo-oophorectomy has

2017 American College of Obstetricians and Gynecologists

99. Choosing the Route of Hysterectomy for Benign Disease

hysterectomy was successful in 88% of cases in which it was planned ( ). Based on these studies and other studies that showed advantages of the vaginal approach to hysterectomy, a laparoscopic approach to hysterectomy does not need to supplant a vaginal approach in order to perform an opportunistic salpingectomy ( ). It should be noted that prophylactic bilateral salpingo-oophorectomy in the setting of a genetic mutation represents a different surgical circumstance. In contrast to elective salpingo (...) -oophorectomy and salpingectomy, prophylactic procedures require a laparoscopic or abdominal approach in order to obtain necessary tissue margins and proper inspection of peritoneal surfaces and the abdominal cavity ( ). Despite the evidence that there is no clinically significant difference in complications (eg, infection; blood loss; urinary tract, bowel, or vascular injury) and there is uncertain benefit in terms of patient outcomes (eg, sexual function, urinary function, or bowel function) between

2017 American College of Obstetricians and Gynecologists

100. The 2017 hormone therapy position statement of The North American Menopause Society

be superiortooralcontraceptivetherapytorestoreormaintain bone mineral density (BMD). OOPHORECTOMY IN PREMENOPAUSAL WOMEN Thesurgicalremovalofbothovariesleadstoamuchmore abrupt loss of ovarian steroids than does natural menopause and includes the loss of estrogen, progesterone, and testos- terone. 100 Vasomotor symptoms as well as a variety of estrogen deficiency-related symptoms and diseases are more frequent and more severe after oophorectomy and can have a major effect on QOL 101,102 and potential AEs on the CV system,bone,mood,sexualhealth (...) ,andcognition,whichhave been shown in observational studies to be lessened by ET. 103 Unless contraindications are present, ET is indicated for women who have had a bilateral oophorectomy and are hypoestrogenictoreducetheriskforVVAanddyspareunia 104 and osteoporosis, 105 with observational data suggesting benefit on atherosclerosis and CVD, 106 and cognitive decline and dementia 107 Key points InwomenwithearlynaturalorsurgicalmenopauseorPOI, early initiation of ET, with endometrial protection if the uterus

2017 The North American Menopause Society

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