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Prophylactic Oophorectomy

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141. 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

142. 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

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

with prudence between 30 and 40 years and not before age 30. ? For women with a proven BRCA1 or BRCA2 mutation (or a similarly high risk, based on other information) and who opt for screening rather than for prophylactic bilateral mastectomy, yearly MRI and yearly mammography with an interval of six months between both examinations can be used from the age of 40 years onwards. ? Ultrasound is useful to reduce the number of false positives when MRI is difficult to interpret. 4.2. Li-Fraumeni syndrome (...) prophylactic bilateral mastectomy. However, the patient should be informed that there is no proof that preventive measures have a benefit overall. 3. FOLLOW-UP OF WOMEN AT HIGH RISK ? For women with a proven TP53 mutation who opt for screening rather than for prophylactic bilateral mastectomy, yearly MRI is recommended from the age of 25 years onwards. ? Yearly mammography is not recommended because of the higher susceptibility to radiation. ? Ultrasound is useful to reduce the number of false positives

2015 Belgian Health Care Knowledge Centre

145. BRCA Mutations: Cancer Risk and Genetic Testing

benefits. For example, research demonstrates that women who underwent bilateral prophylactic salpingo-oophorectomy had a nearly 80% reduction in risk of dying from ovarian cancer, a 56% reduction in risk of dying from breast cancer ( ), and a 77% reduction in risk of dying from any cause during the studies’ follow-up periods ( ). The reduction in breast and ovarian cancer risk from removal of the ovaries and fallopian tubes appears to be similar for carriers of BRCA1 and BRCA2 mutations (...) in the fallopian tubes, so it is essential that they be removed along with the ovaries.) Removing the ovaries may also reduce the risk of breast cancer in women by eliminating a source of that can fuel the growth of some types of breast cancer. Whether bilateral prophylactic mastectomy reduces breast cancer risk in men with a harmful BRCA1 or BRCA2 mutation or a family history of breast cancer isn’t known. Therefore, bilateral prophylactic mastectomy for men at high risk of breast cancer is considered

2019 OHRI

146. Risk Reduction Strategies in Breast Cancer Prevention Full Text available with Trip Pro

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.

2017 European journal of breast health

147. 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

148. Ketoconazole HRA

that the requirement of not less than one decade of medical use in in the applied indication in the EU is fulfilled. The literature provided by the applicant showed that, the clinical use of ketoconazole has been documented since at least the mid-1980 as shown by Angeli A publication dated 1985 describing long-term administration of ketoconazole in 5 women with Cushing's disease and bilateral adrenal hyperplasia. Ketoconazole has then been increasingly used in the management of Cushing’s syndrome on an off-label

2014 European Medicines Agency - EPARs

149. 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

151. 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

152. Genetic Testing and Management of Hereditary Gastrointestinal Cancer Syndromes

and management of extracolonic malignancies Gynecologic malignancies Recommendations 3. Hysterectomy and bilateral salpingo-oophorectomy should be off ered to women who are known LS mutation carriers and who have fi nished child bearing, optimally at age 40–45 years (con- ditional recommendation, low quality of evidence). 4. Screening for endometrial cancer (EC) and ovarian cancer should be off ered to women at risk for or aff ected with LS by endome- trial biopsy and transvaginal ultrasound annually (...) 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

2015 American College of Gastroenterology

153. 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

154. Practice Bulletin: Endometrial Cancer

nervous system; and when preoperative histology demonstrates a high-grade carcinoma (including grade 3 endometrioid, papillary serous, clear cell, and carcinosarcoma) (79–83). What role does a gynecologic oncologist play in the initial management of endometrial cancer? Total hysterectomy with bilateral salpingo-oophorectomy (BSO)—involving removal of the cervix, uterus, fal- lopian tubes, and ovaries—used to be the mainstay of treatment for uterine cancer. In 1988, however, with mounting evidence (...) that an increased risk of endometrial cancer in BRCA mutation carriers may not be due to the mutation per se, but rather to prophylaxis or treatment with tamoxi- fen (59, 60). Thus, for women with BRCA1 or BRCA2 mutations who take tamoxifen, hysterectomy may be con- sidered to reduce the risk of endometrial cancer (59–61). Clinical Presentation The most common symptoms of endometrial cancer are abnormal uterine bleeding (including irregular menses and intermenstrual bleeding) and postmenopausal bleed- ing

2015 Society of Gynecologic Oncology

155. 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

156. 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 (...) or no ovarian involvement/mass are designated as peritoneal primaries. In other words, because these tumours are classified without identifying a defined precursor, their classification is subject to error. In high-risk women with an identified BRCA mutation, bilateral salpingo-oophorectomy offers the greatest risk reduction for ovarian cancer 38 and significant risk reduction for breast cancer. The identification of the fallopian tube as the origin of high-grade pelvic serous carcinomas, and its associated

2014 Royal College of Obstetricians and Gynaecologists

157. International trends in the uptake of cancer risk reduction strategies in women with a BRCA1 or BRCA2 mutation. (Abstract)

and included women from 59 centres from ten countries. Subjects completed a questionnaire at the time of genetic testing, which included past use of cancer prevention options and screening tests. Biennial follow-up questionnaires were administered.Six-thousand two-hundred and twenty-three women were followed for a mean of 7.5 years. The mean age at last follow-up was 52.1 years (27-96 years) and 42.3% of the women had a prior diagnosis of breast cancer. In all, 27.8% had a prophylactic bilateral mastectomy (...) and  64.7% had a BSO. Screening with breast MRI increased from 70% before 2009 to 81% at or after 2009. There were significant differences in uptake of all options by country.For women who received genetic testing more recently, uptake of prophylactic mastectomy and breast MRI is significantly higher than those who received genetic testing more than 10 years ago. However, uptake of both BSO and breast MRI is not optimal, and interventions to increase uptake are needed.

2019 British Journal of Cancer

158. 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. Full Text available with Trip Pro

, 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

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

(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

160. Completeness of salpingectomy intended for ovarian cancer risk reduction. (Abstract)

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

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