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Prophylactic Oophorectomy

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121. Prevention of relapse in patients with acquired thrombotic thrombocytopenic purpura undergoing elective surgery: a case series. (PubMed)

followed for acquired TTP with severe ADAMTS-13 deficiency during remission were candidates for seven elective surgeries (inguinal hernioplasty, cholecystectomy, laparoscopic hysterectomy, oophorectomy, parotidectomy and two total hip arthroplasties). Results Four patients were treated with prophylactic plasma exchange (PEX) therapy immediately before surgery. One patient was treated with PEX therapy before her first surgery and with preemptive rituximab once her second surgery was scheduled. Because (...) Prevention of relapse in patients with acquired thrombotic thrombocytopenic purpura undergoing elective surgery: a case series. Essentials Thrombotic thrombocytopenic purpura (TTP) is a life-threatening disease. Surgery is a possible trigger of acute TTP episodes and no guidelines are available. Six patients with severe ADAMTS-13 deficiency during remission underwent elective surgery. Patients were prophylactically treated to restore ADAMTS-13 activity and no relapses occurred. SUMMARY

2019 Journal of Thrombosis and Haemostasis

122. Recommendations for the management of early breast cancer in women with an identified BRCA1 or BRCA2 gene mutation or at high risk of a gene mutation

oophorectomy/ovarian suppression) should be used when appro- priate based on hormone receptor status to reduce the risk of ipsilateral and con- tralateral events. C Offer similar advice and care, as described in Recommendations 1 & 2 above, to women diagnosed with breast cancer with a strong family history of breast and/or ovarian cancer and no identified BRCA1/2 mutation. Reiner 2013 29 Kirova 2010 13 Brekelmans 2007 15 Tilanus-Linthorst 2006 30 Seynaeve 2004 17 Vlastos 2002 31 D When mastectomy (...) PRACTICE POINT – SYSTEMIC THERAPIES F # Adjuvant endocrine therapy (which may include premenopausal oophorectomy/ ovarian suppression) should be used when appropriate based on hormone recep- tor status to reduce the risk of ipsilateral and contralateral events. RECOMMENDATIONS – SURGICAL RISK-REDUCING STRATEGIES Grade Evidence Statements References Surgical risk-reducing strategies in women diagnosed with breast cancer with a BRCA1/2 mutation 6 Discuss contralateral risk- reducing mastectomy with women

2015 Cancer Australia

123. Li-Fraumeni syndrome: not a straightforward diagnosis anymore-the interpretation of pathogenic variants of low allele frequency and the differences between germline PVs, mosaicism, and clonal hematopoiesis. (PubMed)

, annual breast MRI is recommended and prophylactic mastectomies considered for those with significant family histories. Detection of PVs in cancer susceptibility genes can also lead to recommendations for other prophylactic surgeries (e.g., salpingo-oophorectomy) and increased surveillance for other cancers. Therefore, recognizing when a PV is somatic rather than germline and distinguishing somatic mosaicism from clonal hematopoiesis (CH) is essential. Mutational events that occur at a post-zygotic (...) . In this review, we focus on the challenges of interpreting PVs with low MAF in breast cancer patients undergoing germline testing and the implications for management.The clinical implications of a germline PV are substantial. For PV carriers in high-penetrance genes like BRCA1, BRCA2, and TP53, prophylactic mastectomy is often recommended and radiation therapy avoided when possible for those with Li-Fraumeni syndrome (LFS). For germline PV carriers in more moderate-risk genes such as PALB2, ATM, and CHEK2

2019 Breast cancer research : BCR

124. Completeness of salpingectomy intended for ovarian cancer risk reduction. (PubMed)

Completeness of salpingectomy intended for ovarian cancer risk reduction. Prophylactic salpingectomy has been heavily promoted based on the theory that serous tubal intraepithelial carcinoma is a precursor lesion for serous ovarian carcinoma. However, the validity of prophylactic salpingectomy has yet to be proven through adequate research. The purpose of this study is to evaluate the completeness of salpingectomy intended for ovarian cancer risk reduction.Women without a history of ovarian (...) cancer who were undergoing salpingoophorectomy at a single institution in Honolulu, Hawaii were enrolled in this study. Salpingectomy was performed prior to oophorectomy. A blinded pathologist then examined the ovaries for the presence of residual salpingeal tissue. Data collected included type of surgery (minimally invasive or laparotomy) and level of surgeon (attending or resident). Data were analyzed using Fisher's exact test.A total of 107 ovaries were examined. Following salpingectomy, 5.6% (n 

2019 Gynecologic Oncology

125. Clinical Management of Patients at Risk for Hereditary Breast Cancer with Variants of Uncertain Significance in the Era of Multigene Panel Testing. (PubMed)

(40.5%) of patients of which 26.4% were in high or moderate penetrance genes. P/LP results were found in 61 (10.8%) patients, of which 61.2% were identified in breast-specific moderate and high penetrance genes, and 38.7% were found in non-breast specific genes. Of variants found in high-risk genes, 54.5% were P/LP and 45.5% were VUS. On multivariable analysis, prophylactic mastectomy was associated with younger age and personal history of cancer, but not variant pathogenicity or penetrance (...) . There were no differences in the use of post-test imaging, oophorectomy, or colonoscopy based on variant findings or age.In this era of multigene panel testing, genetic factors help to inform, but not dictate, complex decision-making in surveillance and management of patients at risk for hereditary breast cancer.

2019 Annals of Surgical Oncology

126. Oncogenetic testing and follow-up for women with familial breast/ovarian cancer, Li Fraumeni syndrome and Cowden syndrome

. Early identification of women at risk makes the initiation of life saving strategies possible, including enhanced surveillance, risk reducing surgery (preventive mastectomy or oophorectomy) and chemoprophylaxis. This clinical practice guideline is based on the collaborative efforts of the Belgian Health Care Knowledge Centre (KCE), the College of Human Genetics and the College of Oncology. This guideline complements the recently published practice guideline for breast cancer screening 1 (...) for breast cancer, i.e. Peutz-Jeghers (associated with the STK11 gene), Ataxia Telangiectasia (associated with ATM) and Hereditary Diffuse Gastric Cancer (associated with CDH1), neurofibromatosis type 1 (associated with NF1 mutations) or multiple endocrine neoplasia type 1 (caused by germline mutations in the MEN1 tumor-suppressor gene). 2 Moreover, it does not cover subsequent prophylactic treatment such as chemoprevention (e.g. Tamoxifen) or risk- reducing surgery. 3. METHODS 3.1. Clinical research

2015 Belgian Health Care Knowledge Centre

128. Trends and Factors Affecting Utilization of BRCA Testing in the United States: The Need for Improved Surveillance

decrease morbidity and mortality. Prophylactic mastectomy can reduce the risk of breast cancer by 85–100%, and prophylactic oophorectomy can reduce the risk of ovarian cancer by 69–100% and breast cancer by 37–100%. BRCA test utilization and costs in the United States may be influenced by numerous factors such as increased education, awareness, professional society recommendations, clinical guidelines, scientific evidence, evolving technology, and national policies (e.g. Affordable Care Act (...) of two recent CDC papers on the , and . Women with pathogenic BRCA mutations have an estimated 45–65% risk of breast cancer and a 17–39% risk of ovarian cancer by age 70, as compared with a 7% risk of breast cancer and 0.6% risk of ovarian cancer by age 70 in the general population. Timely ascertainment of BRCA mutation carriers allows for preventive interventions, including enhanced screening, chemoprevention, or prophylactic surgery to remove the breasts and/or ovaries, which can significantly

2017 CDC Genomics and Health Impact Blog

129. Genetic Testing and Management of Hereditary Gastrointestinal Cancer Syndromes

pancreatic cancer-prone family member requires evaluation by centers experienced in the care of these high-risk individuals. Determining when surgery is required for pancreatic lesions is dif? cult and is best individualized after multidisciplinary assess- ment (conditional recommendation, low quality of evidence). Hereditary gastric cancer Hereditary diffuse gastric cancer 25. Management for patients with hereditary diffuse gastric cancer should include: (i) prophylactic gastrectomy after age 20 years (...) for multiple component tumors in terms of age of initiation and intervals between surveil- lance exams, and may lead to the consideration of prophylactic surgery or more extensive surgery in the case of neoplasia devel- opment. Th e diagnosis of an inherited syndrome also has signifi - cant implications for management of the patient’s immediate and extended family. Features of a patient’s personal history may be the initial clue to the possibility of an inherited predisposition to cancer. Hallmark features

2015 American College of Gastroenterology

130. Robotic Surgery in Gynecology

duration and low complexity are unlikely to benefit from robotic-assisted surgery. The College and SGS suggest that there is no advantage, and that there are possible disadvantages, to performing the following procedures with robotic assistance compared with other minimally invasive approaches: Tubal ligation Simple ovarian cystectomy Surgical management of ectopic pregnancy Prophylactic bilateral salpingo-oophorectomy Learning Curve For the surgeon, robot-assisted surgery addresses common problems

2015 American College of Obstetricians and Gynecologists

131. Society of Gynecologic Oncology statement on risk assessment for inherited gynecologic cancer predispositions

, Greene MH. Prophylactic oophorectomy reduces breast cancer penetrance during 6 J.M.Lancaster etal./ GynecologicOncology136 (2015)3–7prospective, long-term follow-up of BRCA1 mutation carriers. J Clin Oncol 2005;23(34):8629–35. [58] Lynch Syndrome. Practice Bulletin No. 147. Society of Obstetricians and Gynecolo- gists.ObstetGynecol 2014;124:1042–54. [59] Schwartz MD,et al. Randomized noninferiority trial of telephone versus in-person genetic counseling for hereditary breast and ovarian cancer. J Clin

2015 Society of Gynecologic Oncology

132. Conservative Surgery and Radiation?Stage I and II Breast Cancer

antiendocrine therapy if appropriate and undergoing prophylactic salpingo-oophorectomy. Bilateral mastectomy for treatment of the affected breast and for risk reduction on the contralateral side is an option that should be considered. Prosthetically Augmented or Reconstructed Breasts The development of significant capsular contracture may be increased after RT. The reported incidence varies widely, but capsular contracture has been reported to occur in 25%–60% of cases [55,56]. Patients should be advised (...) and contralateral prophylactic mastectomy. Ann Surg Oncol. 2009;16(6):1597-1605. 34. Bleicher RJ, Ciocca RM, Egleston BL, et al. Association of routine pretreatment magnetic resonance imaging with time to surgery, mastectomy rate, and margin status. J Am Coll Surg. 2009;209(2):180-187; quiz 294-185. 35. Houssami N, Turner R, Macaskill P, et al. An individual person data meta-analysis of preoperative magnetic resonance imaging and breast cancer recurrence. J Clin Oncol. 2014;32(5):392-401. 36. Cutuli B, Kanoun S

2015 American College of Radiology

134. Management of Cervical Cancer

tumour size (>4 cm), FIGO stage IB2 to IIA 43, level II-2 and the presence of gross vascular erosion. 45, level III The incidence of ovarian metastases in FIGO stages IB to IIB is higher in AC compared to SCC. 44, level III Ovarian preservation is safe during radical surgery in young patients with early stage SCC of cervix. 43, level II-2; 44 - 46, level III The incidence of subsequent complication in the retained ovary is rare. 46, level III However in AC, bilateral salphingo-oophorectomy should (...) may be performed for FIGO stage IA2. ? radical hysterectomy with pelvic lymphadenectomy is the preferred treatment for FIGO stage IB1 cervical cancer. ? concurrent chemoradiotherapy is the preferred treatment for bulky cervical cancer (FIGO stage IB2 and IIA2). ? ovarian preservation during radical surgery may be offered in young patients with early stage squamous cell carcinoma of cervix. However in adenocarcinoma, bilateral salphingo-oophorectomy should be performed. • Laparoscopic and Robotic

2015 Ministry of Health, Malaysia

136. Ovarian tissue cryopreservation: a committee opinion

to immunosuppressive therapy may elect to prophylactically cryopreserve ovarian tissue (6, 8–12). Other potential indications include fertility preservation in patients with genetic mutations that pose a high risk for premature ovarian failure and who are unable to pursue nonexperimental fertility preservation approaches. Ovarian tissue cryopreservation should not be offered to women who wish to delay childbearing or to women with benign conditions such as ovarian cysts that are best managedwithfertility (...) - tion (62). The ?rst case of successful orthotopic autotransplanta- tionofcryopreservedandthawedovariantissuewasdemon- stratedinawomanwhohadpreviouslyundergoneabilateral oophorectomy (45). The ovarian tissue was transplanted into peritonealpocketsinthepelvicperitoneum.Ovulationinduc- tionwithgonadotropinsdemonstratedfolliculardevelopment andovulation,althoughthepatientdidnotconceive.The?rst pregnancy was reported in 2004 in a patient who developed ovarian failure after chemotherapy and radiation

2014 Society for Assisted Reproductive Technology

137. Practice Bulletin: Lynch syndrome

or endometrial cancer, and tumor tissue is available, testing should begin on this Practice Bul le tin No. 147 7 reduction include chemoprevention and prophylactic hysterectomy with bilateral salpingo-oophorectomy. Screening Endometrial cancer screening is not performed in the general population because of the low prevalence of disease, typical early stage of presentation, and recog- nized symptoms of abnormal uterine bleeding. However, Lynch syndrome-associated endometrial cancer may Tumor Testing Results (...) for chemoprevention of endometrial cancer in women with Lynch syndrome. Additional studies using the levonorg- estrel intrauterine system have been proposed. Risk-Reducing Surgery Prophylactic hysterectomy and bilateral salpingo- oophorectomy is a risk-reducing option for women with Lynch syndrome who have completed childbearing. A multicenter retrospective study of 61 women with Lynch syndrome who had undergone hysterectomy, matched to 210 controls with Lynch syndrome, demonstrated that the incidence

2014 Society of Gynecologic Oncology

138. Menopause Chapter 3: Clinical Issues

/antagonist ospemifene is an oral agent for the treatment of moderate to severe dyspareunia due to GSM/VVA. (Level I) Progestogen therapy for endometrial protection is not recommended with the use of low-dose vaginal ET, although studies of endometrial safety with vaginal ET do not extend beyond 1 year. (Level I) In postmenopausal women with recurrent UTIs, consider treatment with low-dose vaginal ET or prophylactic antibiotics. (Level I) Any bleeding in a postmenopausal woman, including postcoital (...) oophorectomy before age 48 years may be advised that taking ET until the typical age at menopause appears to lower the risk of dementia later in life. (Level II) In perimenopausal and postmenopausal women, HT should not be used to improve cognitive skills. (Level III) In older postmenopausal women, HT should not be used to prevent dementia or treat Alzheimer disease. (Level I) Interventions that reduce cardiovascular risk, including smoking cessation, weight management, regular aerobic exercise

2014 The North American Menopause Society

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