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Prophylactic Oophorectomy

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101. Prevention and Screening in BRCA Mutation Carriers and Other Breast/Ovarian Hereditary Cancer Syndromes

, Eisen A et al. Breast cancer risk after bilateral prophylactic oophorectomy in BRCA1 mutation carriers. J Natl Cancer Inst 1999; 91: 1475–1479. 35. Rebbeck TR, Kauff ND, Domchek SM. Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers. J Natl Cancer Inst 2009; 101: 80–87. 36. Heemskerk-Gerritsen BA, Seynaeve C, van Asperen CJ et al. Breast cancer risk after salpingo-oophorectomy in healthy BRCA1/2 mutation carriers (...) ; 32: 1547–1553. 41. Marchetti C, De Felice F, Palaia I 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. 42. Swanson CL, Bakkum-Gamez JN. Options in prophylactic surgery to prevent ovarian cancer in high-risk women: how new hypotheses of fallopian tube origin in?uence recommendations. Curr Treat Options Oncol 2016; 17: 20. 43. Shapira M, Raanani H, Feldman B

2017 European Society for Medical Oncology

102. Lymphangioleiomyomatosis Diagnosis and Management Part I: An Official ATS/JRS Clinical Practice Guideline

invasive management (conditional recommendation based on very low-quality evidence). d We suggest NOT using doxycycline as treatment for LAM (conditional recommendation based on low-quality evidence). d WesuggestNOTusinghormonal therapy as treatment for LAM (conditional recommendation based on very low- quality evidence). Hormonal therapies include progestins, gonadotrophin- releasing hormone agonists, selective estrogen receptor modulators like tamoxifen, and oophorectomy. ORCID ID: 0000-0001-7168 (...) for LAM. (“Hormonal therapy” includes the progestins, GnRH agonists, selective estrogen receptor modulators like tamoxifen, and oophorectomy.) Conditional Very low VEGF-D as a diagnostic test For patients whose CT scan shows cystic abnormalities characteristic of LAM but have no con?rmatory clinical or extrapulmonary radiologic features of LAM, we recommend VEGF-D testing before consideration of proceeding to diagnostic lung biopsy. (“Con?rmatory features of LAM” include tuberous sclerosis complex

2016 American Thoracic Society

103. Fertility problems: assessment and treatment

#notice-of-rights). Page 16 of 511.3.13.3 Prophylactic antibiotics should be considered before uterine instrumentation if screening has not been carried out. [2004] [2004] 1.4 Medical and surgical management of male factor fertility problems 1.4.1 1.4.1 Medical management (male factor infertility) Medical management (male factor infertility) 1.4.1.1 Men with hypogonadotrophic hypogonadism should be offered gonadotrophin drugs because these are effective in improving fertility. [2004] [2004] 1.4.1.2

2013 National Institute for Health and Clinical Excellence - Clinical Guidelines

104. Guideline on the management of premature ovarian insufficiency

for treatment of vaginal discomfort and dyspareunia for women not using HRT. C NEUROLOGICAL HEALTH What are the consequences of POI on neurological function? The possible detrimental effect on cognition should be discussed when planning hysterectomy and/or oophorectomy under the age of 50 years, especially for prophylactic reasons. D What are the management options for the effect of POI on neurological function? Estrogen replacement to reduce the possible risk of cognitive impairment should be considered (...) to Turner Syndrome should be offered HRT throughout the normal reproductive lifespan. C BRCA gene mutation or after breast cancer HRT is generally contra-indicated in breast cancer survivors. B HRT is a treatment option for women carrying BRCA1/2 mutations but without personal history of breast cancer after prophylactic bilateral salpingo- oophorectomy (BSO). C Endometriosis For women with endometriosis who required oophorectomy, combined estrogen/progestogen therapy can be effective for the treatment

2015 European Society of Human Reproduction and Embryology

105. Ovarian Epithelial, Fallopian Tube, and Primary Peritoneal Cancer Treatment (PDQ®): Health Professional Version

to earlier detection. For women at increased risk, prophylactic oophorectomy may be considered after age 35 years if childbearing is complete. In a family-based study among 551 women with BRCA1 or BRCA2 mutations, of the 259 women who had undergone bilateral prophylactic oophorectomy, 2 (0.8%) developed subsequent papillary serous peritoneal carcinoma, and 6 (2.8%) had stage I ovarian cancer at the time of surgery. Of the 292 matched controls, 20% who did not have prophylactic surgery developed ovarian (...) cancer. Prophylactic surgery was associated with a reduction in the risk of ovarian cancer that exceeded 90% (relative risk, 0.04; 95% confidence interval, 0.01–0.16), with an average follow-up of 9 years;[ ] however, family-based studies may be associated with biases resulting from case selection and other factors that influence the estimate of benefit.[ ] After a prophylactic oophorectomy, a small percentage of women may develop a primary peritoneal carcinoma that is similar in appearance

2018 PDQ - NCI's Comprehensive Cancer Database

106. Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Prevention (PDQ®): Health Professional Version

of ovarian cancer observed among women with a BRCA1 or BRCA2 mutation. Study Design : Multiple case-control studies. Internal Validity : Good. Consistency : Good. External Validity : Good. Risk-reducing bilateral salpingo-oophorectomy: harms Based on solid evidence, prophylactic oophorectomy among women who are still menstruating at the time of surgery is associated with infertility, vasomotor symptoms, decreased sexual interest, vaginal dryness, urinary frequency, decreased bone-mineral density (...) : Good. External Validity : Good. Risk-reducing bilateral salpingo-oophorectomy: benefits Based on solid evidence, risk-reducing bilateral salpingo-oophorectomy is associated with a decreased risk of ovarian cancer. Peritoneal carcinomatosis has been reported rarely following surgery. Risk-reducing surgery is generally reserved for women at high risk of developing ovarian cancer, such as women who have an inherited susceptibility to ovarian cancer. Magnitude of Effect : 90% reduction in risk

2018 PDQ - NCI's Comprehensive Cancer Database

107. 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

108. Cancer Genetics Risk Assessment and Counseling (PDQ®): Health Professional Version

. For example, bilateral salpingo-oophorectomy in a premenopausal woman significantly reduces the risk of ovarian and breast cancers. This may mask underlying hereditary predisposition to these cancers. Current age (if living). Age at death and cause of death (if deceased). Carcinogenic exposures (e.g., alcohol and tobacco use, sun exposure, radiation exposure, asbestos exposure) or other known cancer site-specific risk factors. Prior germline genetic testing results. Prior tumor testing results (including

2018 PDQ - NCI's Comprehensive Cancer Database

109. Breast Cancer Prevention (PDQ®): Health Professional Version

produced an overestimate. Study Design : Evidence obtained from case-control and cohort studies. Internal Validity : Good. Consistency : Good. External Validity : Good. Prophylactic oophorectomy or ovarian ablation: benefits Based on solid evidence, premenopausal women with BRCA gene mutations who undergo prophylactic oophorectomy have lower breast cancer incidence. Similarly, oophorectomy or ovarian ablation is associated with decreased breast cancer incidence in normal premenopausal women (...) and in women with increased breast cancer risk resulting from thoracic irradiation. Magnitude of Effect : Breast cancer incidence is decreased by 50%, but published study designs may have produced an overestimate. Study Design : Observational, case-control, and cohort studies. Internal Validity : Good. Consistency : Good. External Validity : Good. Prophylactic oophorectomy or ovarian ablation: harms Based on solid evidence, castration may cause the abrupt onset of menopausal symptoms such as hot flashes

2018 PDQ - NCI's Comprehensive Cancer Database

110. Genetics of Colorectal Cancer (PDQ®): Health Professional Version

cancers associated with the syndrome. For example, regular has been shown to improve survival. Prophylactic surgery (colectomy) has also been shown to improve survival in . The timing and extent of risk-reducing surgery usually depends on the number of polyps, their size, histology, and symptomatology. For and a diagnosis of CRC, extended resection is associated with fewer metachronous CRCs and additional surgical procedures for colorectal neoplasia than in patients who undergo segmental resection

2018 PDQ - NCI's Comprehensive Cancer Database

111. Genetics of Breast and Gynecologic Cancers (PDQ®): Health Professional Version

observational Million Women’s Study in the United Kingdom.[ ] The risk of breast cancer was not elevated, however, in women randomly assigned to estrogen-only versus placebo in the WHI study (RR, 0.77; 95% CI, 0.59–1.01). Eligibility for the estrogen-only arm of this study required hysterectomy, and 40% of these patients also had undergone oophorectomy, which potentially could have impacted breast cancer risk.[ ] The association between HRT and breast cancer risk among women with a family history of breast (...) tested for BRCA1/BRCA2 pathogenic variants.[ ] Short-term use of hormones for treatment of menopausal symptoms appears to confer little or no breast cancer risk.[ , ] The effect of HRT on breast cancer risk among carriers of BRCA1 or BRCA2 pathogenic variants has been studied in the context of bilateral risk-reducing oophorectomy, in which short-term replacement does not appear to reduce the protective effect of oophorectomy on breast cancer risk.[ ] (Refer to the section of this summary for more

2018 PDQ - NCI's Comprehensive Cancer Database

112. Unusual Cancers of Childhood Treatment (PDQ®): Health Professional Version

be considered to decrease permanent damage to those structures.[ ] Total thyroidectomy also optimizes the use of radioactive iodine for imaging and treatment. Central neck dissection: A therapeutic central neck lymph node dissection should be done in the presence of clinical evidence of central or lateral neck metastases.[ ] For patients without clinical evidence of gross extrathyroidal invasion or locoregional metastasis, a prophylactic central neck dissection may be considered on the basis of tumor (...) focality and size of the primary tumor. However, because of the increased morbidity associated with central lymph node dissection, it is important to carefully individualize each case on the basis of the risks and benefits of the extent of dissection.[ ] Lateral neck dissection: Cytological confirmation of metastatic disease to lymph nodes in the lateral neck is recommended before surgery. Routine prophylactic lateral neck dissection is not recommended. Classification and risk assignment.[ ] Despite

2018 PDQ - NCI's Comprehensive Cancer Database

113. Risk Reduction Strategies in Breast Cancer Prevention (PubMed)

of the patient herself, earlier and more frequent clinical assessment, and the use of imaging screening. Agents such as tamoxifen, raloxifene and aromatase inhibitors may be used in chemoprevention and may reduce the risk substantially. The risks and benefits must be assessed, and one must discuss with the patient her adverse events and the decision regarding the best treatment. Women who carry the BRCA1/2 mutation (very high risk) can benefit from prophylactic surgical interventions, such as bilateral (...) mastectomy and/or bilateral salpingo-oophorectomy. This group of patients must be monitored by a multidisciplinary team, providing explanations prior to surgery regarding the surgical treatment offered, the reconstruction techniques, and the risks and complications.

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2017 European journal of breast health

114. Breast Cancer Treatment (PDQ®): Health Professional Version

of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial. Lancet 383 (9922): 1041-8, 2014. [ ] Hartmann LC, Schaid DJ, Woods JE, et al.: Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med 340 (2): 77-84, 1999. [ ] Rebbeck TR, Levin AM, Eisen A, et al.: Breast cancer risk after bilateral prophylactic oophorectomy in BRCA1 mutation carriers. J Natl Cancer Inst 91 (17): 1475-9 (...) , 1999. [ ] Kauff ND, Satagopan JM, Robson ME, et al.: Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med 346 (21): 1609-15, 2002. [ ] Rebbeck TR, Lynch HT, Neuhausen SL, et al.: Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med 346 (21): 1616-22, 2002. [ ] Kauff ND, Domchek SM, Friebel TM, et al.: Risk-reducing salpingo-oophorectomy for the prevention of BRCA1- and BRCA2-associated breast and gynecologic cancer: a multicenter

2018 PDQ - NCI's Comprehensive Cancer Database

116. Management of Women with a Genetic Predisposition to Gynaecological Cancers

or BRCA2 mutation. N Engl J Med 2002;346:1609–15. 17. Rebbeck TR, Lynch HT, Neuhausen SL, Narod SA, van’t Veer L, Garber JE, et al. Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med 2002;346:1616–22. 18. 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;26:1331–7. 19. Finch A, Beiner M (...) HT. Intra-abdominal carcinomatosis after prophylactic oophorectomy in women of hereditary breast ovarian cancer syndrome kindreds associated with BRCA1 and BRCA2 mutations. Gynecol Oncol 2005;97:457–67. 22. 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;304:967–75. 23. Domchek SM, Friebel TM, Neuhausen SL, Wagner T, Evans G, Isaacs C, et al. Mortality after

2015 Royal College of Obstetricians and Gynaecologists

117. Breast Cancer Prevention (PDQ®): Health Professional Version

produced an overestimate. Study Design : Evidence obtained from case-control and cohort studies. Internal Validity : Good. Consistency : Good. External Validity : Good. Prophylactic oophorectomy or ovarian ablation: benefits Based on solid evidence, premenopausal women with BRCA gene mutations who undergo prophylactic oophorectomy have lower breast cancer incidence. Similarly, oophorectomy or ovarian ablation is associated with decreased breast cancer incidence in normal premenopausal women (...) and in women with increased breast cancer risk resulting from thoracic irradiation. Magnitude of Effect : Breast cancer incidence is decreased by 50%, but published study designs may have produced an overestimate. Study Design : Observational, case-control, and cohort studies. Internal Validity : Good. Consistency : Good. External Validity : Good. Prophylactic oophorectomy or ovarian ablation: harms Based on solid evidence, castration may cause the abrupt onset of menopausal symptoms such as hot flashes

2018 PDQ - NCI's Comprehensive Cancer Database

118. Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: a systematic review to update the U.S. Preventive Services Task Force Recommendation

studies) : There were no trials that evaluated the efficacy of risk-reducing medications in mutation carriers. Three trials in women at various risk levels showed reduced risks for oestrogen receptor positive cancer in those treated with prophylactic tamoxifen or raloxifene. Higher rates of several categories of adverse events were reported in women in these active treatment groups, including thromboembolic events and endometrial events including cancer. Surgery (six studies) : Three studies reported (...) the impact of bilateral mastectomies. Two found a reduced incidence of breast cancer occurred in the intervention group compared with non-operated carriers. Surgical complications were frequent. Another reported less anxiety in women after surgery but no change on other psychological measures. One study of salpingo-oophorectomy and one of oophorectomy reported reduced incidences of ovarian cancer or breast cancer (one study each). Two other small studies described some adverse effects of oophorectomy

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2014 DARE.

119. The Distal Fallopian Tube as the Origin of Non-uterine Pelvic High-grade Serous Carcinomas

and pathological findings of prophylactic salpingo-oophorectomy specimens from 159 BRCA1 and BRCA2 carriers. Seven (4.4%) occult fallopian tube cancers were identified in these women, in the absence of symptoms. These and other observations have led to increased pathological scrutiny of fallopian tubes in prophylactic specimens from high-risk women. Medeiros et al. 26 published a pilot study of 13 BRCA-positive women undergoing prophylactic bilateral salpingo-oophorectomy. The authors outlined a protocol (...) , Ning G, Bijron JG, Howitt BE, Jimenez CA, et al. Through the glass darkly: intraepithelial neoplasia, top-down differentiation, and the road to ovarian cancer. J Pathol 2013;231:402–12. 24. Woolas R, Jacobs I, Davies AP, Leake J, Brown C, Grudzinskas JG, et al. What is the true incidence of primary fallopian tube carcinoma? Int J Gynecol Cancer 1994;4:384–8. 25. Finch A, Shaw P, Rosen B, Murphy J, Narod SA, Colgan TJ. Clinical and pathologic findings of prophylactic salpingo-oophorectomies in 159

2014 Royal College of Obstetricians and Gynaecologists

120. Ovarian cancer

cycles, including: An increasing numbers of pregnancies [ ]. Breastfeeding [ ]. The use of the combined oral contraceptive pill [ ; ]. Early menopause. Tubal ligation, and possibly hysterectomy [ ; ; ]. Prophylactic oophorectomy [ ]. Prognosis What is the prognosis? The survival rate for ovarian cancer is strongly related to the stage of the disease at the time of diagnosis. Generally, women diagnosed with early (stage I or II) ovarian cancer have a better one-year survival than those diagnosed

2018 NICE Clinical Knowledge Summaries

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