- Email: [email protected]
Cancer risks in women from BRCA-negative hereditary breast and ovarian cancer families
Abstracts / Gynecologic Oncology 130 (2013) e1–e169
significantly more likely to use additional testing in hysterectomy vs. intact uterus patients (33% vs. 24%, P = 0.02). CA-125 and ultrasound were the most common additional post-RRSO surveillance techniques in patients with an intact uterus (18%) while CA-125 surveillance was most common in hysterectomy patients (27%). Conclusions: Current RRSO practice routinely incorporates pelvic washings, serial sectioning, and minimally invasive approaches. Concomitant hysterectomy is frequently performed, especially in patients who plan to use HRT or have used tamoxifen. Many respondents felt that BRCA mutations may increase uterine cancer risk. There was no consensus regarding the need or specific practice for surveillance after RRSO. doi:10.1016/j.ygyno.2013.04.306
248 Comparing coordinated versus sequential salpingo-oophorectomy for BRCA1 and BRCA2 mutation carriers with breast cancer J. Chapman1, A. Panighetti2, S. Hwang3, B. Crawford4, B. Powell5, J. Chan4, L. Chen4. 1University of California San Francisco, San Francisco, CA, 2University of Washington Medical Center, Seattle, WA, 3Duke University Medical Center, Durham, NC, 4UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, 5Kaiser Permanente, San Francisco, CA. Objective: Women with breast cancer who carry BRCA1 or BRCA2 (BRCA1/2) mutations must also consider risk-reducing salpingooophorectomy (RRSO) and how to coordinate this procedure with their breast cancer surgery. This retrospective study investigated the factors that contribute to a patient’s decision to have coordinated vs. sequential surgery and compared the surgical outcomes of each. Methods: We queried our Cancer Risk Program database for patients who had breast cancer and a known BRCA1/2 mutation prior to undergoing breast surgery. Women who chose concurrent RRSO at the time of breast surgery were compared to those who did not. Results: There were 47 patients who knew their mutation carrier status before undergoing breast cancer surgery. Of these, 27 (57%) chose coordinated surgeries, 12 (26%) underwent sequential surgeries, and 8 (17%) elected against RRSO with a median follow-up time of 3.5 years (range, 1.4-11.9 years). Patients who elected coordinated surgery were 4.4 years older than their sequential peers and 10 years older than their non-RRSO peers (P = 0.02). There were no significant differences in medical comorbidities or use of neoadjuvant therapy among the 3 groups. Total operating time was significantly different in each of the groups; sequential surgery patients had the longest operating times (median = 8.43 hours), followed by combined surgery patients (median = 7.42 hours) and patients who declined RRSO (median = 3.97 hours) (P = 0.0007). Estimated blood loss and total length of hospital stay were not significantly different among groups. There were 8 minor postoperative complications in the coordinated group and no complications in the sequential group (P = 0.04). Conclusions: Coordinating RRSO with breast surgery is associated with increased age and decreased total operating room time. These findings are important factors to consider in counseling this unique group of patients. doi:10.1016/j.ygyno.2013.04.307
e105
249 Cancer risks in women from BRCA-negative hereditary breast and ovarian cancer families K. Long, M. Pike, E. Otegbeye, A. Arnold, Z. Stadler, M. Robson, R. Barakat, K. Offit, D. Chi, N. Kauff. Memorial Sloan-Kettering Cancer Center, New York, NY. Objective: While the cancer risks associated with BRCA mutations are wellcharacterized, there are limited data to guide the counseling and management of women with family histories suspicious for hereditary breast and ovarian cancer who are BRCAnegative (BRCAneg). The goal of this study was to prospectively determine the incidence of new breast cancer (BC) and ovarian cancer (OC) in women from BRCAneg breast and ovarian cancer families. Methods: From 1/1/02 to 2/28/11, all women undergoing counseling and testing for BRCA mutations at our institution were offered participation in an institutional review board-approved prospective cohort study. For the current analysis, participants were included if they personally had a diagnosis of either BC ≤ age 60 years (yrs) or OC at any age, had at least one additional first- or second-degree female relative with BC ≤ age 60 yrs or OC at any age, and were BRCAneg. Pedigrees were reviewed and kindreds were classified as site-specific breast (SSB) or hereditary breast-ovary (HBO). Participants were contacted via mailed questionnaire and asked to report on new cancer diagnoses since genetic testing. For women with prior BC, only the contralateral breast was considered to be at risk. If a participant had bilateral mastectomy, bilateral oophorectomy, or bilateral BC prior to receipt of genetic testing results, the relevant tissue was not considered to be at risk. For each participant with tissue at risk, woman-years at risk were calculated as the time from genetic testing to date of completion of the questionnaire. Expected cancer incidence was determined using age-specific SEER data. The rates of observed-to-expected cancers were analyzed using a Poisson distribution events test. Results: Of 2,559 BRCAneg women ascertained during the study period, 664 met the personal and family history inclusion criteria. Follow-up questionnaires were completed by 419 (63%) participants a median of 5.3 years after genetic testing. Among 320 women with breast tissue at risk, there were 13 new BC in SSB kindreds (3.76 expected, P b 0.001) and 2 new BC in HBO kindreds (1.46 expected, P = 0.43) (Table). Among 347 women with ovarian tissue at risk, there were 0 new OC in SSB kindreds (0.45 expected), and 2 new OC in HBO kindreds (expected 0.10, P = 0.005). Conclusions: Affected women from BRCAneg SSB kindreds were confirmed to have an increased rate of new BC but not OC. Additionally, these results suggest that BRCAneg women from HBO kindreds have an increased risk of OC, but not BC. Table. Rate of Observed-to-Expected New Cancers.
doi:10.1016/j.ygyno.2013.04.308
significantly more likely to use additional testing in hysterectomy vs. intact uterus patients (33% vs. 24%, P = 0.02). CA-125 and ultrasound were the most common additional post-RRSO surveillance techniques in patients with an intact uterus (18%) while CA-125 surveillance was most common in hysterectomy patients (27%). Conclusions: Current RRSO practice routinely incorporates pelvic washings, serial sectioning, and minimally invasive approaches. Concomitant hysterectomy is frequently performed, especially in patients who plan to use HRT or have used tamoxifen. Many respondents felt that BRCA mutations may increase uterine cancer risk. There was no consensus regarding the need or specific practice for surveillance after RRSO. doi:10.1016/j.ygyno.2013.04.306
248 Comparing coordinated versus sequential salpingo-oophorectomy for BRCA1 and BRCA2 mutation carriers with breast cancer J. Chapman1, A. Panighetti2, S. Hwang3, B. Crawford4, B. Powell5, J. Chan4, L. Chen4. 1University of California San Francisco, San Francisco, CA, 2University of Washington Medical Center, Seattle, WA, 3Duke University Medical Center, Durham, NC, 4UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, 5Kaiser Permanente, San Francisco, CA. Objective: Women with breast cancer who carry BRCA1 or BRCA2 (BRCA1/2) mutations must also consider risk-reducing salpingooophorectomy (RRSO) and how to coordinate this procedure with their breast cancer surgery. This retrospective study investigated the factors that contribute to a patient’s decision to have coordinated vs. sequential surgery and compared the surgical outcomes of each. Methods: We queried our Cancer Risk Program database for patients who had breast cancer and a known BRCA1/2 mutation prior to undergoing breast surgery. Women who chose concurrent RRSO at the time of breast surgery were compared to those who did not. Results: There were 47 patients who knew their mutation carrier status before undergoing breast cancer surgery. Of these, 27 (57%) chose coordinated surgeries, 12 (26%) underwent sequential surgeries, and 8 (17%) elected against RRSO with a median follow-up time of 3.5 years (range, 1.4-11.9 years). Patients who elected coordinated surgery were 4.4 years older than their sequential peers and 10 years older than their non-RRSO peers (P = 0.02). There were no significant differences in medical comorbidities or use of neoadjuvant therapy among the 3 groups. Total operating time was significantly different in each of the groups; sequential surgery patients had the longest operating times (median = 8.43 hours), followed by combined surgery patients (median = 7.42 hours) and patients who declined RRSO (median = 3.97 hours) (P = 0.0007). Estimated blood loss and total length of hospital stay were not significantly different among groups. There were 8 minor postoperative complications in the coordinated group and no complications in the sequential group (P = 0.04). Conclusions: Coordinating RRSO with breast surgery is associated with increased age and decreased total operating room time. These findings are important factors to consider in counseling this unique group of patients. doi:10.1016/j.ygyno.2013.04.307
e105
249 Cancer risks in women from BRCA-negative hereditary breast and ovarian cancer families K. Long, M. Pike, E. Otegbeye, A. Arnold, Z. Stadler, M. Robson, R. Barakat, K. Offit, D. Chi, N. Kauff. Memorial Sloan-Kettering Cancer Center, New York, NY. Objective: While the cancer risks associated with BRCA mutations are wellcharacterized, there are limited data to guide the counseling and management of women with family histories suspicious for hereditary breast and ovarian cancer who are BRCAnegative (BRCAneg). The goal of this study was to prospectively determine the incidence of new breast cancer (BC) and ovarian cancer (OC) in women from BRCAneg breast and ovarian cancer families. Methods: From 1/1/02 to 2/28/11, all women undergoing counseling and testing for BRCA mutations at our institution were offered participation in an institutional review board-approved prospective cohort study. For the current analysis, participants were included if they personally had a diagnosis of either BC ≤ age 60 years (yrs) or OC at any age, had at least one additional first- or second-degree female relative with BC ≤ age 60 yrs or OC at any age, and were BRCAneg. Pedigrees were reviewed and kindreds were classified as site-specific breast (SSB) or hereditary breast-ovary (HBO). Participants were contacted via mailed questionnaire and asked to report on new cancer diagnoses since genetic testing. For women with prior BC, only the contralateral breast was considered to be at risk. If a participant had bilateral mastectomy, bilateral oophorectomy, or bilateral BC prior to receipt of genetic testing results, the relevant tissue was not considered to be at risk. For each participant with tissue at risk, woman-years at risk were calculated as the time from genetic testing to date of completion of the questionnaire. Expected cancer incidence was determined using age-specific SEER data. The rates of observed-to-expected cancers were analyzed using a Poisson distribution events test. Results: Of 2,559 BRCAneg women ascertained during the study period, 664 met the personal and family history inclusion criteria. Follow-up questionnaires were completed by 419 (63%) participants a median of 5.3 years after genetic testing. Among 320 women with breast tissue at risk, there were 13 new BC in SSB kindreds (3.76 expected, P b 0.001) and 2 new BC in HBO kindreds (1.46 expected, P = 0.43) (Table). Among 347 women with ovarian tissue at risk, there were 0 new OC in SSB kindreds (0.45 expected), and 2 new OC in HBO kindreds (expected 0.10, P = 0.005). Conclusions: Affected women from BRCAneg SSB kindreds were confirmed to have an increased rate of new BC but not OC. Additionally, these results suggest that BRCAneg women from HBO kindreds have an increased risk of OC, but not BC. Table. Rate of Observed-to-Expected New Cancers.
doi:10.1016/j.ygyno.2013.04.308