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Gynecologic health surveillance and outcomes in BRCA mutation carriers following risk-reducing salpingo-oophorectomy
Abstracts / Gynecologic Oncology 141 (2016) 2–208
142 - Featured Poster Session Gynecologic health surveillance and outcomes in BRCA mutation carriers following risk-reducing salpingo-oophorectomy E.N. Prendergast, M. Green, M. Zakhour, J. Lester, A.J. Li, C. Walsh, B.J. Rimel, R.S. Leuchter, B.Y. Karlan, I. Cass. Cedars-Sinai Medical Center, Los Angeles, CA, USA
DP
Objectives: To characterize patterns of gynecologic surveillance for BRCA1 and BRCA2 mutation carriers following risk-reducing salpingo-oophorectomy (RRSO). Methods: An institutional review board–approved, retrospective review of health surveillance among BRCA1/2 mutation carriers following RRSO was performed. Women with BRCA1 or BRCA2 mutations who underwent RRSO were identified from the years 2000 to 2013. Women with occult carcinoma at RRSO were excluded from analysis. The frequency of hormone replacement therapy (HRT or ERT), abnormal uterine bleeding, and cervical pathology were abstracted. Results: One hundred ninety-two BRCA mutation carriers underwent RRSO: 112 BRCA1, 73 BRCA2, 5 BRCA1&2 and 2 BRCA-NOS with median ages of 46, 46, 46, and 43, respectively (P = NS). Median follow-up was 6.5 years. Seventy-nine (41%) women had a prior diagnosis of breast cancer. Seventy-nine (41%) women had a concomitant hysterectomy including 53% (n = 36) with a prior diagnosis of breast cancer. Breast cancer was not associated a higher likelihood of hysterectomy (P = .12). Of eligible women, 68 (35%) received either HRT or ERT for an average of 4 ± 3.3 years. Women who had concomitant hysterectomy were more likely to use hormone therapy than women whose uterus remained in situ (46% vs 35%, respectively, P = .01). Concomitant hysterectomy did not affect the median length of HRT use (4 vs 5 years for women with an intact uterus). Of eligible women without breast cancer, premenopausal women were more likely to use ERT/HRT than postmenopausal women (52% vs 3%, P = .0001). Thirteen (11.5%) women with a uterus had abnormal bleeding during the follow-up period. Ten underwent endometrial biopsy with 1 diagnosis of cancer. Six women (5%) had abnormal cervical cytology which necessitated excisional biopsy in 1 patient for cervical intraepithelial neoplasia type III. Conclusions: Use of HRT/ERT is common in BRCA mutation carriers following RRSO. BRCA mutation carriers who have a concomitant hysterectomy or are premenopausal at the time of RRSO are more likely to use HRT. Women who keep their uterus are at low risk of subsequent cervical or uterine pathology.
OF
doi:10.1016/j.ygyno.2016.04.173
following RRSO was performed from 2000 to 2013. Women with occult carcinoma at RRSO were excluded from analysis. Surveillance for primary serous peritoneal cancer (PSPC) after RRSO was recorded. Statistical analysis was done using the Wilcoxon matched-pairs signed rank test and analysis of variance. Results: We identified 192 BRCA mutation carriers who underwent RRSO: 112 BRCA1, 73 BRCA2, 5 BRCA1&2, and 2 BRCA-NOS. Median duration of follow up was 6.5 years (0.1–15.6). Seventy-nine (41%) women had a concomitant hysterectomy. Following RRSO, 43 women underwent at least 1surveillance ultrasound for PSPC; 6 underwent further negative evaluation. Ninety-nine women (52%) underwent CA125 surveillance. Of these women, 33 (17%) had annual and 46 (24%) semiannual CA-125 levels. Median change in pre- and postsurgical CA-125 values was greater in women who were premenopausal before RRSO compared with women who were postmenopausal (–3 vs –1.5 units/mL, P = .01). Median CA-125 value after RRSO was unaffected by whether or not a patient had a concomitant hysterectomy (P = .12) or used HRT/ERT (P = .06). One asymptomatic patient had an abnormal CA125 because of recurrent breast cancer. Three symptomatic patients (2%) were diagnosed with PSPC with elevated CA-125 and imaging demonstrating ascites and carcinomatosis. Conclusions: Primary peritoneal carcinoma after RRSO is rare (2%). Pelvic ultrasound and CA-125 may have limited usefulness in surveillance for PSPC but alternatively should be used to evaluate symptoms. Premenopausal women had a greater change in CA-125 values after RRSO than premenopausal women.
RO
screening. Past age 60 years at OC diagnosis, RRM is unlikely to be cost-effective, with diminishing gains in life expectancy.
59
doi:10.1016/j.ygyno.2016.04.175
CO
RR
EC
TE
144 - Featured Poster Session Examination of the time interval between diagnoses in women with metachronous primary endometrial and colorectal cancers supporting universal Lynch testing K.S. Grzankowskia, J.B. Szendera, C.L. Spring-Robinsonb, R. Brightwella, S.B. Lelea, K.O. Odunsia, P.J. Fredericka. aRoswell Park Cancer Institute, Buffalo, NY, USA, bState University of New York, University at Buffalo, Buffalo, NY, USA
UN
doi:10.1016/j.ygyno.2016.04.174
143 - Featured Poster Session Primary peritoneal carcinoma surveillance practices following risk-reducing salpingo-oophorectomy (RRSO) in BRCA mutation carriers E.N. Prendergast, M. Green, M. Zakhour, J. Lester, A.J. Li, C. Walsh, B.J. Rimel, R.S. Leuchter, B.Y. Karlan, I. Cass. Cedars-Sinai Medical Center, Los Angeles, CA, USA Objectives: To describe primary peritoneal cancer surveillance among BRCA1 and BRCA2mutation carriers following risk-reducing salpingo-oophorectomy (RRSO). Methods: An institutional review board–approved, retrospective review of health surveillance among BRCA1/2mutation carriers
Objectives: The time interval between diagnoses of endometrial and colorectal cancers is not well established in women with metachronous primary tumors of both sites. We sought to examine the time interval between diagnoses, identify associations with clinicopathologic factors, and compare current genetic screening practices. Methods: We identified 53 patients who developed both cancers between 1966 and 2014. These patients were divided into 2 groups based on having colorectal (group 1) or endometrial (group 2) cancer first. Risks of MLH1, MSH2, MSH6, or BRCA1/2mutations as well as the chance of developing a subsequent ovarian or breast cancer were estimated. Results: There were 18 and 35 patients in groups 1 and 2, respectively. The mean time interval was longer in group 2, 70 vs 43 months. (See Table 1a.) Median progression-free survival (PFS) and overall survival (OS) for endometrial cancer tended to be longer in group 2 (PFS: 66 vs 58 mo and OS: 77 vs 58 mo). Median PFS and OS for colorectal cancer were significantly longer in group 1 (PFS: 22 vs 74 mo and OS: 22 vs 86 mo). (See Table 1b.) The estimated risk of any MMR mutations was at least 25% in most patients, with 21 patients having more than 50% and 13 patients more than 75%. Conclusions: The mean estimated prevalence of MMR mutation in patients with metachronous endometrial and colorectal cancers is 100-fold greater than in the general population. The time interval between the diagnosis of endometrial and colorectal carcinomas is 5.8 years if endometrial cancer develops first and 3.5 years if
142 - Featured Poster Session Gynecologic health surveillance and outcomes in BRCA mutation carriers following risk-reducing salpingo-oophorectomy E.N. Prendergast, M. Green, M. Zakhour, J. Lester, A.J. Li, C. Walsh, B.J. Rimel, R.S. Leuchter, B.Y. Karlan, I. Cass. Cedars-Sinai Medical Center, Los Angeles, CA, USA
DP
Objectives: To characterize patterns of gynecologic surveillance for BRCA1 and BRCA2 mutation carriers following risk-reducing salpingo-oophorectomy (RRSO). Methods: An institutional review board–approved, retrospective review of health surveillance among BRCA1/2 mutation carriers following RRSO was performed. Women with BRCA1 or BRCA2 mutations who underwent RRSO were identified from the years 2000 to 2013. Women with occult carcinoma at RRSO were excluded from analysis. The frequency of hormone replacement therapy (HRT or ERT), abnormal uterine bleeding, and cervical pathology were abstracted. Results: One hundred ninety-two BRCA mutation carriers underwent RRSO: 112 BRCA1, 73 BRCA2, 5 BRCA1&2 and 2 BRCA-NOS with median ages of 46, 46, 46, and 43, respectively (P = NS). Median follow-up was 6.5 years. Seventy-nine (41%) women had a prior diagnosis of breast cancer. Seventy-nine (41%) women had a concomitant hysterectomy including 53% (n = 36) with a prior diagnosis of breast cancer. Breast cancer was not associated a higher likelihood of hysterectomy (P = .12). Of eligible women, 68 (35%) received either HRT or ERT for an average of 4 ± 3.3 years. Women who had concomitant hysterectomy were more likely to use hormone therapy than women whose uterus remained in situ (46% vs 35%, respectively, P = .01). Concomitant hysterectomy did not affect the median length of HRT use (4 vs 5 years for women with an intact uterus). Of eligible women without breast cancer, premenopausal women were more likely to use ERT/HRT than postmenopausal women (52% vs 3%, P = .0001). Thirteen (11.5%) women with a uterus had abnormal bleeding during the follow-up period. Ten underwent endometrial biopsy with 1 diagnosis of cancer. Six women (5%) had abnormal cervical cytology which necessitated excisional biopsy in 1 patient for cervical intraepithelial neoplasia type III. Conclusions: Use of HRT/ERT is common in BRCA mutation carriers following RRSO. BRCA mutation carriers who have a concomitant hysterectomy or are premenopausal at the time of RRSO are more likely to use HRT. Women who keep their uterus are at low risk of subsequent cervical or uterine pathology.
OF
doi:10.1016/j.ygyno.2016.04.173
following RRSO was performed from 2000 to 2013. Women with occult carcinoma at RRSO were excluded from analysis. Surveillance for primary serous peritoneal cancer (PSPC) after RRSO was recorded. Statistical analysis was done using the Wilcoxon matched-pairs signed rank test and analysis of variance. Results: We identified 192 BRCA mutation carriers who underwent RRSO: 112 BRCA1, 73 BRCA2, 5 BRCA1&2, and 2 BRCA-NOS. Median duration of follow up was 6.5 years (0.1–15.6). Seventy-nine (41%) women had a concomitant hysterectomy. Following RRSO, 43 women underwent at least 1surveillance ultrasound for PSPC; 6 underwent further negative evaluation. Ninety-nine women (52%) underwent CA125 surveillance. Of these women, 33 (17%) had annual and 46 (24%) semiannual CA-125 levels. Median change in pre- and postsurgical CA-125 values was greater in women who were premenopausal before RRSO compared with women who were postmenopausal (–3 vs –1.5 units/mL, P = .01). Median CA-125 value after RRSO was unaffected by whether or not a patient had a concomitant hysterectomy (P = .12) or used HRT/ERT (P = .06). One asymptomatic patient had an abnormal CA125 because of recurrent breast cancer. Three symptomatic patients (2%) were diagnosed with PSPC with elevated CA-125 and imaging demonstrating ascites and carcinomatosis. Conclusions: Primary peritoneal carcinoma after RRSO is rare (2%). Pelvic ultrasound and CA-125 may have limited usefulness in surveillance for PSPC but alternatively should be used to evaluate symptoms. Premenopausal women had a greater change in CA-125 values after RRSO than premenopausal women.
RO
screening. Past age 60 years at OC diagnosis, RRM is unlikely to be cost-effective, with diminishing gains in life expectancy.
59
doi:10.1016/j.ygyno.2016.04.175
CO
RR
EC
TE
144 - Featured Poster Session Examination of the time interval between diagnoses in women with metachronous primary endometrial and colorectal cancers supporting universal Lynch testing K.S. Grzankowskia, J.B. Szendera, C.L. Spring-Robinsonb, R. Brightwella, S.B. Lelea, K.O. Odunsia, P.J. Fredericka. aRoswell Park Cancer Institute, Buffalo, NY, USA, bState University of New York, University at Buffalo, Buffalo, NY, USA
UN
doi:10.1016/j.ygyno.2016.04.174
143 - Featured Poster Session Primary peritoneal carcinoma surveillance practices following risk-reducing salpingo-oophorectomy (RRSO) in BRCA mutation carriers E.N. Prendergast, M. Green, M. Zakhour, J. Lester, A.J. Li, C. Walsh, B.J. Rimel, R.S. Leuchter, B.Y. Karlan, I. Cass. Cedars-Sinai Medical Center, Los Angeles, CA, USA Objectives: To describe primary peritoneal cancer surveillance among BRCA1 and BRCA2mutation carriers following risk-reducing salpingo-oophorectomy (RRSO). Methods: An institutional review board–approved, retrospective review of health surveillance among BRCA1/2mutation carriers
Objectives: The time interval between diagnoses of endometrial and colorectal cancers is not well established in women with metachronous primary tumors of both sites. We sought to examine the time interval between diagnoses, identify associations with clinicopathologic factors, and compare current genetic screening practices. Methods: We identified 53 patients who developed both cancers between 1966 and 2014. These patients were divided into 2 groups based on having colorectal (group 1) or endometrial (group 2) cancer first. Risks of MLH1, MSH2, MSH6, or BRCA1/2mutations as well as the chance of developing a subsequent ovarian or breast cancer were estimated. Results: There were 18 and 35 patients in groups 1 and 2, respectively. The mean time interval was longer in group 2, 70 vs 43 months. (See Table 1a.) Median progression-free survival (PFS) and overall survival (OS) for endometrial cancer tended to be longer in group 2 (PFS: 66 vs 58 mo and OS: 77 vs 58 mo). Median PFS and OS for colorectal cancer were significantly longer in group 1 (PFS: 22 vs 74 mo and OS: 22 vs 86 mo). (See Table 1b.) The estimated risk of any MMR mutations was at least 25% in most patients, with 21 patients having more than 50% and 13 patients more than 75%. Conclusions: The mean estimated prevalence of MMR mutation in patients with metachronous endometrial and colorectal cancers is 100-fold greater than in the general population. The time interval between the diagnosis of endometrial and colorectal carcinomas is 5.8 years if endometrial cancer develops first and 3.5 years if