Risk-Reducing Bilateral Salpingo-Oophorectomy for Ovarian Cancer: A Review and Clinical Guide for Hereditary Predisposition Genes

Pathogenic germline variants underlie up to 20% of ovarian cancer (OC) and are associated with varying degrees of risk for OC. For mutations in high-penetrance genes such as / , the role of risk-reducing bilateral salpingo-oophorectomy (RRSO) in cancer prevention is well-established and improves mor...

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Vydané v:JCO oncology practice Ročník 18; číslo 3; s. 201
Hlavní autori: Liu, Ying L, Breen, Kelsey, Catchings, Amanda, Ranganathan, Megha, Latham, Alicia, Goldfrank, Deborah J, Grisham, Rachel N, Long Roche, Kara, Frey, Melissa K, Chi, Dennis S, Abu-Rustum, Nadeem, Aghajanian, Carol, Offit, Kenneth, Stadler, Zsofia K
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States 01.03.2022
Predmet:
Female
Genetic Predisposition to Disease
Humans
Mutation
Ovarian Neoplasms - genetics
Ovarian Neoplasms - prevention & control
Ovarian Neoplasms - surgery
Risk Factors
Salpingo-oophorectomy
ISSN:2688-1535, 2688-1535
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Shrnutí:Pathogenic germline variants underlie up to 20% of ovarian cancer (OC) and are associated with varying degrees of risk for OC. For mutations in high-penetrance genes such as / , the role of risk-reducing bilateral salpingo-oophorectomy (RRSO) in cancer prevention is well-established and improves mortality. However, in moderate-penetrance genes where the degree of risk for OC is less precisely defined, the role of RRSO is more controversial. Although national guidelines have evolved to incorporate gene-specific recommendations, studies demonstrate significant variations in practice. Given this, our multidisciplinary group has reviewed the available literature on risk estimates for genes associated with OC, incorporated levels of evidence, and set thresholds for consideration of RRSO. We found that the benefit of RRSO is well-established for pathogenic variants in /2 as well as and / where the risk of OC is elevated beyond our threshold for RRSO. In , RRSO is particularly controversial as newer studies consistently demonstrate an increased risk of OC that is dependent on family history, making uniform recommendations challenging. Additionally, new guidelines for Lynch syndrome provide gene-specific risks, questioning the role of RRSO, and even hysterectomy, for and mutation carriers. Given these uncertainties, shared decision making should be used around RRSO with discussion of individual risk factors, family history, and adverse effects of surgery and premature menopause. Herein, we provide a clinical guide and counseling points.
Bibliografia:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
ObjectType-Review-3
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ISSN:2688-1535
2688-1535
DOI:10.1200/OP.21.00382