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Prophylactic Oophorectomy

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161. 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

162. Preoperative Risk Assessment Among Women Undergoing Bilateral Prophylactic Mastectomy for Cancer Risk Reduction. (Abstract)

Preoperative Risk Assessment Among Women Undergoing Bilateral Prophylactic Mastectomy for Cancer Risk Reduction. Cancer risk assessment is an important decision-making tool for women considering irreversible risk-reducing surgery. Our objective was to determine the prevalence of BRCA testing among women undergoing bilateral prophylactic mastectomy (BPM) and to review the characteristics of women who choose BPM within a metropolitan setting.We retrospectively reviewed records of women who (...) not tested.From January 2002 to July 2009, a total of 71 BPMs were performed. Only 25 women (35.2%) had preoperative BRCA testing; 88% had a BRCA mutation. Compared with tested women, BRCA nontested women were significantly older (39.1 vs. 49.2 years, P < 0.001), had significantly more preoperative biopsies and mammograms and had fewer previous or simultaneous cancer risk-reducing surgery (oophorectomy). Among BRCA nontested women, common indications for BPM were family history of breast cancer (n = 21, 45.6

2011 Annals of Surgical Oncology

163. 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

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

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 (...) using prophylaxis to restore ADAMTS-13 activity. Further observational studies or randomized clinical trials are needed to confirm whether prophylactic PEX could be the key factor in preventing relapse.© 2019 International Society on Thrombosis and Haemostasis.

2019 Journal of Thrombosis and Haemostasis

166. International trends in the uptake of cancer risk reduction strategies in women with a BRCA1 or BRCA2 mutation. Full Text available with Trip Pro

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

167. 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

168. 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

169. 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

170. PMS2 germline mutation c.1577delA (p.Asp526Alafs*69)-induced Lynch syndrome-associated endometrial cancer: A case report. Full Text available with Trip Pro

months.The patient was diagnosed with cervix CIN III, endometrial cancer (EC), anemia, and LS.Total hysterectomy, bilateral salpingectomy, pelvic lymphadenectomy were performed for treating EC, while ovariectomy was refused by the patient. The patient underwent postoperative chemotherapy with paclitaxel combined with carboplatin for 6 courses of treatment. Laparoscopic partial enterectomy was applied for treating colon cancer 5 years later after the surgery treatment for EC. Besides, Sanger sequencing (...) years.Carrying PMS2 germline mutation (c.1577delA) confers an extremely high susceptibility of suffering from LS-associated cancers. Thus, close clinical monitoring and prophylactic surgery are highly recommended to reduce the morbidity and mortality of LS-associated cancers.

2019 Medicine

171. 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 (...) et al. BRCA mutation carriers show normal ovarian response in in vitro fertilization cycles. Fert Steril 2015; 104: 1162–1167. 44. Peccatori FA, Azim HA, Jr, Orecchia R et al. Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2013; 24 (Suppl. 6): vi160–vi170. 45. Rebbeck TR, Friebel T, Wagner T et al. Effect of short-term hormone replacement therapy on breast cancer risk reduction after bilateral prophylactic oophorectomy in BRCA1

2017 European Society for Medical Oncology

172. 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

173. 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

174. 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

175. 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

176. 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

177. 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

178. Breast cancer susceptibility 1 and 2 (BRCA1/2) gene testing for hereditary breast and ovarian cancer (HBOC)

), prophylactic mastectomy and salpingo-oophorectomy, and chemoprevention. Final publication URL The report may be purchased from: Indexing Status Subject indexing assigned by CRD MeSH Breast Neoplasms; Genes, BRCA1; Genes, BRCA2s; Genetic Predisposition to Disease; Ovarian Neoplasms Language Published English Country of organisation United States English summary An English language summary is available. Address for correspondence HAYES, Inc., 157 S. Broad Street, Suite 200, Lansdale, PA 19446, USA. Tel: 215

2013 Health Technology Assessment (HTA) Database.

179. The BRCA 1/2 gene mutation test to evaluate the risks of breast and ovarian cancer

as mutation carriers may use chemoprevention to reduce their risks. 10% will undergo a prophylactic bilateral mastectomy and 40% will undergo a prophylactic salpingo-oophorectomy. 5 These interventions reduce cancer risks but some treated women will still have cancer. ? Anxiety Positive test results disclose genetic information about individuals and family members. This may create anxiety for individuals and tension within families. ? Confidentiality Individuals known to be mutation carriers may (...) and control of obesity, limiting alcohol consumption and dietary fat 2. Cancer screening or surveillance 3. Chemoprevention (e. g. tamoxifen, raloxifene) 4. Risk-reducing surgery (mastectomy, salpingo-oophorectomy) Who might consider being tested? 1- Individuals who have a family history of: ? known BRCA1/2 mutation ? ovarian cancer in 2 or more relatives, at any age ? ovarian cancer at any age AND breast cancer under the age of 60 in 3 or more relatives ? breast cancer in 3 or more relatives average age

2014 Cancer Council Australia

180. 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

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