Incidence and Risk Factors of Ovarian Cancer and Breast Cancer Following Prophylactic Surgery: A Retrospective Cohort Study

Abstract

Objective:

The purpose of this study was to review the clinical variables associated with developing a breast or ovarian cancer in women diagnosed with a positive BRCA1/2 germline mutation or a family history of breast or ovary cancer who underwent risk-reducing surgery during a 15-year period.

Materials and Methods:

We retrospectively evaluated women with either a positive BRCA germline mutation or a significant family history of breast or ovarian cancer who underwent risk-reducing surgery during a 15-year period. The study's relevant clinical variables included BRCA gene status, menopausal status, parity, history of breast cancer, prior tamoxifen use, or hormone replacement therapy (HRT), contraception use, concurrent prophylactic breast and gynecologic surgery, surgery type (e.g., endoscopic or abdominal bilateral salpingo-oophorectomy, abdominal or laparoscopic hysterectomy with bilateral salpingo oophorectomy), the manifestation of a breast (primary or recurrent) cancer or primary peritoneal cancer (PPC), and overall patient survival.

Results:

We identified 231 women who underwent prophylactic surgery of whom 5 developed a PPC, whereas 1 subject was intraoperatively diagnosed with an occult fallopian tube cancer; there were also 15 cases of breast cancer (7 new diagnoses and 8 recurrent cases) observed throughout the study. A prior use of HRT (p < 0.001) and a history of breast cancer (p = 0.032) were significantly associated with an increased risk for developing a primary/recurrent breast neoplasm or a PPC. In addition, surgery type (p < 0.0001) was a significant prognostic indicator for decreased patient survival (11 of the risk-reducing surgery expired patients underwent either an abdominal [n = 8] or a laparoscopic bilateral salpingo-oophorectomy [n = 3]).

Conclusion:

In this investigation, 21 (9.1%) of the subjects developed a primary or recurrent breast cancer or a PPC during the 15-year surveillance period. The data indicate that previous use of HRT and a history of breast cancer significantly contributed to the development of a new or recurrent breast cancer or a PPC. Moreover, undergoing an abdominal bilateral salpingo-oophorectomy was a prognostic indicator for decreased patient survival. (J GYNECOL SURG 36:189)