Outcome of surveillance and prophylactic salpingo-oophorectomy in asymptomatic women at high risk for ovarian cancer
Introduction
It is estimated that 5% of all cases of ovarian cancer are caused by hereditary factors. BRCA1/2 mutation carriers have a highly increased risk of breast and ovarian cancer. The cumulative lifetime risk of developing ovarian cancer for these women is estimated to be 13–63% [1], [2], [3], [4], [5], [6], [7], [8]. Family cancer clinics have been instituted worldwide to provide counseling, genetic testing, surveillance programs, and prophylactic surgery, aiming at early detection or prevention of ovarian (and breast) cancer in these high-risk women. Surveillance protocols for ovarian cancer vary between clinics, but at minimum consist of transvaginal ultrasound and CA125 measurements. Many reports on the efficacy of surveillance for ovarian cancer have been published [9], [10], [11], [12], [13], [14], [15], [16]. However, it remains unclear whether surveillance results in a reduction of the mortality and/or morbidity rate of ovarian cancer. Moreover, negative effects such as unnecessary surgical intervention and related complications are rarely taken into account. In this report, we describe the first results of the surveillance program for ovarian cancer in high-risk women, as performed between 1994 and 2000 at the family cancer clinic of our institution. The outcome of the surveillance program for breast cancer in this population has been reported elsewhere [17], [18], [19].
Section snippets
Patient selection and counseling
In a historic cohort study, we analyzed the data from all women at high risk of ovarian cancer due to a genetic predisposition or family history, who were screened at the Rotterdam Family Cancer Clinic, from January 1, 1994 until December 31, 2000. All women with a personal history of ovarian cancer were excluded. All participants were members from hereditary breast and/or ovarian cancer families [HB(O)C], as defined by the criteria shown in Table 1. Women were counseled with regard to their
Population characteristics
A total of 383 women was included, of whom the main characteristics are shown in Table 2. There were 127 BRCA1 and 25 BRCA2 mutation carriers (39.7%). 306 (80%) women were premenopausal. During the study period, a total of 1273 surveillance visits was made, with a mean of 2.6 visits per women. Only 8 women entered the surveillance program after PBSO; all other women had at least 1 screening visit before an eventual PBSO. In 11 women, surveillance started before 30 years, due to various reasons.
Discussion
Although the population we screened is at high risk for ovarian cancer, as indicated by the high percentage (39.7%) of BRCA1/2 mutation carriers, we only found one primary ovarian cancer that was not screen detected. This is a low yield, compared to the incidence of 32 per 1000 PY (95% C.I. 9–55 per 1000 PY), as reported by Scheuer et al. [16]. Most likely this can be explained by the age difference of the 2 populations studied (mean age in our study: 40.0 years, in the Scheuer study: 47.7
Acknowledgment
The authors would like to thank Ms. E. Crepin for her help with the collection of the data.
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