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Prophylactic Oophorectomy

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81. Reproductive and hormonal considerations in women at increased risk for hereditary gynecologic cancers: SGO and ASRM Evidence-Based Review

is unknown (23). The levonorgestrol intrauterine system is also associated with lower endometrial cancer risk and has been used in treating early low-grade disease, but there are limited data for chemoprevention in Lynch Syndrome (24, 25). 3.2.3.Riskreducingsurgery. WomenwithLynchSyndrome should consider prophylactic total hysterectomy and bilateral salpingo-oophorectomy (THBSO) at the completion of child- bearing, especially after the age of 40 years (4). THBSO has (...) ),dependingonthegene. (See Table 1). 3.SURVEILLANCE,CHEMOPREVENTION,AND RISK–REDUCINGSURGERYFOR GYNECOLOGICCANCERS To reduce gynecologic cancer risk, women may opt for sur- geriessuchasrisk-reducingbilateralsalpingo-oophorectomy (RRSO), bilateral salpingectomy or hysterectomy. Because hereditary cancers are associated with a relatively younger age of onset, risk-reducing surgeries are generally recommended between the ages of 35–45, or when childbearing is complete. These risk-reducing procedures may result

2020 Society for Assisted Reproductive Technology

82. Recommendations for good practice in Ultrasound: Oocyte retrieval

sperm retrieval) can be considered. In any case, patients should be counselled on the possibility of such complications and informed consent should be obtained before starting the OPU procedure. Antibiotic prophylaxis Patients with history of endometriosis, pelvic inflammatory disease (PID), pelvic adhesions, dermoids, or previous pelvic surgery can be considered at high risk for pelvic infection. In these patients, administration of antibiotics is recommended shortly before or during OPU (according (...) to local protocols). There is no evidence for the use of antibiotic prophylaxis in low risk patients, and this can be decided according to local protocols and regulations, taking into account generic antibiotic resistance (Aslam et al., 2018) and the lack of studies on the effect on uterine environment. Further evidence (studies or observational/audit data) should be collected on infection rates and their association with antibiotic administration. Change to transmyometrial or laparoscopic oocyte

2019 European Society of Human Reproduction and Embryology

83. Management of Appendiceal Neoplasms

macroscopic ovarian metastasis, microscopic involvement of the contralateral ovary was found in 18 (45%) of 40. Of 141 patients in whom both ovaries were macroscopically normal, 24 (17%) of 141 had microscopic ovarian involvement. Given the risk of occult ovarian me- tastases in this patient population, bilateral salpingo-oo- phorectomy should be strongly considered, and patients should be appropriately counseled preoperatively. 128 The management of patients with limited peritoneal involvement

2020 American Society of Colon and Rectal Surgeons

84. Clinical Utility Card - Heritable mutations which increase risk in colorectal and endometrial cancer

more intensive surveillance Endometrial and ovarian ? hysterectomy and risk reducing salpingo-oophorectomy (RRSO) are interventions which significantly reduce the risk of both endometrial and ovarian cancer Familial adenomatous polyposis ? systematic reviews have found that registration in dedicated registers, surveillance and colectomy are associated with a consistent and significant reduction in incidence and CRC-related mortality 12. Economic evaluation Stepped results of the economic analyses (...) $2,053,227 Predictive tests $340 $380,564 $386,765 $392,927 $399,077 $405,210 Genetic counselling $337 $957,450 $973,051 $988,552 $1,004,026 $1,019,455 Total net cost to MBS of genetic testing and counselling $3,266,361 $3,319,585 $3,372,468 $3,425,258 $3,477,892 MBS = Medicare Benefits Schedule However these estimates do not consider the anticipated downstream costs or savings associated with surveillance, prophylactic surgeries or cancer treatments. A significant proportion of these downstream services

2019 Medical Services Advisory Committee

85. Hysterectomy for Benign Gynaecologic Indications

bleeding, and correct anemia. Risks and benefits of medical treatment should be discussed preoperatively (High). 10 Mechanical bowel preparation is not routinely required prior to gynaecologic surgery for benign disease (High). 11 Removal of normal ovaries at the time of hysterectomy decreases the risk of ovarian cancer but may be associated with health ramifications. Bilateral oophorectomy may lead to acute development of menopausal symptoms in premenopausal women and has not been shown to offer (...) to decrease risk of venous thromboembolism are recommended for all patients undergoing hysterectomy (Strong, High). 5 Women should be counselled about the benefits and risks of removing the ovaries at the time of the hysterectomy. This should include discussion about the risk of ovarian cancer as well as the long-term health implications of earlier menopause linked to bilateral oophorectomy (Strong, Moderate). 6 Opportunistic salpingectomy can be considered at the time of hysterectomy but the planned

2019 Society of Obstetricians and Gynaecologists of Canada

86. Management of Hereditary Breast Cancer

a protective effect of CRRM on OS in BRCA1 mutation carriers diagnosed with breast cancer before 50 years of age, but not in noncarriers; and van Sprundel et al reported that, in BRCA mutation carriers with unilateral invasive breast cancer, OS was 94% in the contralateral prophylactic mastectomy group versus 77% in the surveillance group ( P = .03), although this effect was no longer statistically significant after adjusting for bilateral prophylactic oophorectomy (BPO). van Sprundel et al observed (...) whether contralateral risk-reducing mastectomy improved survival in a series of women with unilateral breast cancer and BRCA1/2 mutations. In women (n = 105) who elected to have CRRM, the 10-year OS was 89%; in the group (n = 593) of women who did not undergo CRRM, the 10-year OS was 71% ( P < .001). In a separate matched case-control analysis designed to control for potential confounding factors (the effect of bilateral risk-reducing salpingo-oophorectomy [RRSO], stage at diagnosis, and tumor

2020 American Society of Clinical Oncology Guidelines

87. Position Statement – Testing for ovarian cancer in asymptomatic women: Technical Report

be recommended for routine use in a population screening setting. Surveillance of women at high or potentially high risk of ovarian cancer ? Ovarian cancer surveillance is not recommended for women at high or potentially high risk. ? Evidence shows that ultrasound or CA125, singly or in combination, is not effective at detecting early ovarian cancer. ? The most effective risk reducing strategy for ovarian cancer is bilateral salpingo-oophorectomy. Definition of potentially high risk women The category (...) not a criterion ? Post-menopausal women, defined as either (a) >12 months amenorrhoea following a natural menopause or hysterectomy, or (b) >12 months of HRT commenced for menopausal symptoms ? 50 to 74 years of age Exclusion criteria ? Previous diagnosis of lung, colorectal, or ovarian cancer ? Previous oophorectomy (dropped in 1996) ? Current tamoxifen use (dropped in 1999) Increased risk of familial ovarian cancer not a criterion ? Previous ovarian malignancy ? History of bilateral oophorectomy ? Active

2019 Cancer Australia

88. Hysterectomy

when conservative therapy has failed to control bleeding (II-B). 2. Tubo-ovarian abscesses that are ruptured or do not respond to antibiotics may be treated with hysterectomy and bilateral salpingo-oophorectomy in selected cases (I-C). 3. Hysterectomy may be required for cases of acute menorrhagia refractory to medical or conservative surgical treatment (II-C). Other Indications 1. Consultation with an oncologist or geneticist is recommended when considering hysterectomy and prophylactic (...) oophorectomy for a familial history of ovarian cancer (III-C). Surgical Approach 1. The vaginal route should be considered as a first choice for all benign indications. The laparoscopic approach should be considered when it reduces the need for a laparotomy (III-B). Validation Medline searches were performed in preparing this guideline with input from experts in their field across Canada. The guideline was reviewed and accepted by SOGC Council and Executive. Sponsor The Society of Obstetricians

2018 Society of Obstetricians and Gynaecologists of Canada

89. Gynaecologic Management of Hereditary Breast and Ovarian Cancer

for publication. The quality of evidence was rated using the criteria described in the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology framework ( Table 1 ). The interpretation of strong and conditional (weak) recommendations is described in Table 2. The Summary of Findings is available upon request. Benefits, Harms, and Costs We may expect a risk reduction of up to 90% in women predisposed to HBOC who undergo risk-reducing bilateral salpingo-oophorectomy. The harms (...) (strong, moderate). 17 After a breast cancer diagnosis, risk-reducing salpingo-oophorectomy for breast cancer mortality reduction should be considered within 2 years to BRCA1 carriers, and for BRCA2 carriers as part of their breast cancer treatment if considered appropriate by their oncologist (strong, high). 18 Bilateral salpingectomy alone for ovarian/tubal/peritoneal cancer risk reduction in BRCA variant carriers is still under investigation and should only be offered as an alternative to risk

2018 Society of Obstetricians and Gynaecologists of Canada

90. Quality indicators for the management of head and neck squamous cell carcinoma

versus standard radiotherapy for HNC (C-ART); combined hypofractionated stereotactic body radiotherapy with immunomodulating systemic therapy for inoperable recurrent HNC: detection of the maximum tolerated dose; SPECT-CT lymphoscintigraphy for individualized superselective prophylactic nodal irradiation in cN0 HNSCC: a phase I/II study; self-administration of buccal low-level laser therapy (LLLT) in oropharyngeal and buccal mucositis induced by (chemo)RT of HNC); Lisa Licitra (Several studies as PI

2019 Belgian Health Care Knowledge Centre

91. 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

92. Molecular testing strategies for Lynch syndrome in people with colorectal cancer

. Reducing the acceptance of colonoscopy surveillance by people with confirmed Lynch syndrome causing mutations from 97% (as in the base-case analysis) to 70% increased the ICERs for strategies compared with no testing (for example, to £12,632 per QAL Y gained for strategy 5). 4.48 In the base-case analysis, disutility associated with prophylactic hysterectomy and bilateral salpingo-oophorectomy was assumed to be 0. Increasing the disutility value to 0.04 for 1 year increased the ICERs for all strategies (...) (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 20 of 37references costs (2014/15 and updated to 2016/17 prices), identified literature, the British national formulary (BNF 2016) and the NHS drug tariff. Health-r Health-related quality of life and quality-adjusted life-y elated quality of life and quality-adjusted life-year decr ear decrements ements 4.27 Utilities associated with colorectal cancer, endometrial cancer and prophylactic hysterectomy were taken from published

2017 National Institute for Health and Clinical Excellence - Diagnostics Guidance

94. Information for women considering preventive mastectomy

mutations: a critical review of the literature.” International Journal of Cancer. 112(3): 357-64. Frost, M. H., J. M. Slezak, et al. (2005). “Satisfaction After Contralateral Prophylactic Mastectomy: The Signi? cance of Mastectomy Type, Reconstructive Complications, and Body Appearance.” Journal of Clinical Oncology. 23(31): 7849-56. Hartmann, L. C., D. J. Schaid, et al. (1999). “Ef? cacy of Bilateral Prophylactic Mastectomy in Women with a Family History of Breast Cancer.” New England Journal (...) of Medicine. 340(2): 77-84. Hartmann, L.C., T.A. Sellers, et al (2001). “Ef? cacy of Bilateral Prophylactic Mastectomy in BRCA1 and BRCA2 Gene Mutation Carriers”. Journal of the National Cancer Institute. 93(1): 1633-37. Marteau, T. and M. Richards (1996). “The Troubled Helix”., Cambridge University Press. Metcalfe, K. A., J. L. Semple, et al. (2004). “Satisfaction with breast reconstruction in women with bilateral prophylactic mastectomy: a descriptive study.” Plastic and Reconstructive Surgery. 114(2

2019 European Society of Endocrinology

95. Management of genitourinary syndrome of menopause in women with or at high risk for breast cancer: consensus recommendations from The North American Menopause Society and The International Society for the Study of Women’s Sexual Health

disease, given that prophylactic oophorectomy decreases the risk of the devel- opment of new breast cancer in women at risk but without cancer and in survivors with mutations. 115 Nevertheless, despitealackofdata,inwomenwhoarelong-termsurvivors ofER-negativediseaseforwhichriskofrecurrenceislowand symptomatology is troubling, consideration of local HT is reasonable. Women with metastatic disease Women with metastatic breast cancer are a diverse group with significant heterogeneity in prognosis (...) breast cancer risk in carriers of the BRCA1orBRCA2mutationwithintactbreasts,afindingcon- cordant with a systematic review. 114 However, risk-reducing CONSENSUS RECOMMENDATIONS Menopause, Vol. 25, No. 6, 2018 7 Copyright 2018 The North American Menopause Society. Unauthorized reproduction of this article is prohibited.salpingo-oophorectomy in patients with BRCA1 and BRCA2 mutationswasassociatedwithalowerriskofbothdevelopinga first diagnosis of breast cancer and breast cancer-specific mortality

2019 The North American Menopause Society

96. Placenta Accreta Spectrum

of the fetus (attempts at placental removal are associated with significant risk of hemorrhage). Many standard routine operative procedures, including use of standard perioperative antibiotic prophylaxis, remain applicable ( ). Many clinicians will rapidly close the uterine incision and then proceed with hysterectomy after verification that the placenta will not spontaneously deliver. Attempts at forced placental removal often result in profuse hemorrhage and are strongly discouraged (24, 26 (...) ( , ). The dose should be 1 g intravenously within 3 hours of birth. A second dose may be given 0.5–23.5 hours later if bleeding persists (75). Prophylactic tranexamic acid given at the time of delivery after cord clamping may reduce the risk of hemorrhage with placenta accreta spectrum. A recent meta-analysis showed decreased bleeding when tranexamic acid is given prophylactically at the time of cesarean delivery ( ). However, many of the studies had flawed designs or small numbers of patients, and rare

2019 American College of Obstetricians and Gynecologists

97. Opportunistic Salpingectomy as a Strategy for Epithelial Ovarian Cancer Prevention

pelvic surgery about the risks and benefits of salpingectomy should include an informed consent discussion about the role of oophorectomy and bilateral salpingo-oophorectomy. Bilateral salpingo-oophorectomy that causes surgical menopause reduces the risk of ovarian cancer but may increase the risk of cardiovascular disease, cancer other than ovarian cancer, osteoporosis, cognitive impairment, and all-cause mortality. Salpingectomy at the time of hysterectomy or as a means of tubal sterilization (...) are undergoing routine pelvic surgery about the risks and benefits of salpingectomy should include an informed consent discussion about the role of oophorectomy and bilateral salpingo-oophorectomy. Although data are limited, postpartum salpingectomy and salpingectomy at time of cesarean delivery appear feasible and safe. The risks and benefits of salpingectomy should be discussed with patients who desire permanent sterilization. Plans to perform an opportunistic salpingectomy should not alter the intended

2019 American College of Obstetricians and Gynecologists

98. Risk factors for breast cancer: A review of the evidence 2018

with breast cancer aged G) that was associated with a higher risk of breast cancer than truncating mutations (RR 8.0, 95% CI 2.3– 27.4) in a case–control family study. 95 A meta–analysis by Aloraifi et al. 100 included 15 case–control studies of breast cancer risk in high–risk groups (cases with family history of breast cancer, bilateral breast cancer and/or early onset of breast cancer). For protein truncating mutations in the ATM gene, the pooled odds ratio for breast cancer was 3.2 (95 CI 2.04–5.04 (...) of breast cancer in women with breast cancer referred for hereditary cancer genetic testing compared with controls, using results of germline multigene panel tests. CDH1 mutations were detected in 23 of 37,277 breast cancer cases and in three of 25,961 controls, and were associated with increased risk of breast cancer (OR 5.34, 95% CI 1.60–20.94). Breast cancer cases qualifying for clinical genetic testing were enriched for a clinical history of early–onset, bilateral, and triple–negative breast disease

2018 Cancer Australia

99. BRCA-Related Cancer: Risk Assessment, Genetic Counseling, and Genetic Testing

studies of high-risk women and women who were BRCA1/2 mutation carriers, risk-reducing surgery such as mastectomy (6 studies), oophorectomy (7 studies), or salpingo-oophorectomy (2 studies) , were associated with reduced risk for breast or ovarian cancer. Bilateral mastectomy was associated with a 90% to 100% reduced breast cancer incidence and 81% to 100% reduced breast cancer mortality. Oophorectomy was associated with 81% to 100% reduced ovarian cancer incidence. In general (...) mastectomy and salpingo-oophorectomy. Relevant USPSTF Recommendations The USPSTF recommends that clinicians offer to prescribe risk-reducing medications such as tamoxifen, raloxifene, or aromatase inhibitors to women at increased risk for breast cancer and at low risk for adverse medication effects. It recommends against the routine use of medications for risk reduction of primary breast cancer in women not at increased risk for breast cancer. The USPSTF recommends against screening for ovarian cancer

2019 U.S. Preventive Services Task Force

100. 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 (...) . Adjuvant gestagen therapy 58 8.1.2. Adjuvant chemotherapy 58 8.2. Adjuvant medical therapy for carcinosarcomas 59 8.3. Supportive therapy 59 © Leitlinienprogramm Onkologie | Guideline on the Diagnosis, Treatment, and Follow-up of Patients with Endometrial Cancer | April 2018 5 8.3.1. Chemotherapy-induced nausea and vomiting 59 8.3.2. Diarrhea/enteritis 61 8.3.3. Treatment for anemia 62 8.3.4. Prophylaxis against febrile neutropenia with G-CSF 62 8.3.5. Mucositis 63 9. Follow-up / recurrence

2018 German Guideline Program in Oncology

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