J Gynecol Oncol.  2017 Jan;28(1):e3. 10.3802/jgo.2017.28.e3.

Pathologic findings at risk-reducing salpingo-oophorectomy (RRSO) in germline BRCA mutation carriers with breast cancer: significance of bilateral RRSO at the optimal age in germline BRCA mutation carriers

• Lee YJ
• Lee SW
• Kim KR
• Jung KH
• Lee JW
• Kim YM

• KMID: 2413850
• DOI: http://doi.org/10.3802/jgo.2017.28.e3

Abstract

OBJECTIVE
Most BRCA1/2 carriers do not undergo risk-reducing salpingo-oophorectomy (RRSO) by the recommended age. This study aimed to find the incidence of precursor lesions and cancer after RRSO.
METHODS
We retrospectively reviewed breast cancer patients identified as BRCA mutation carriers who underwent RRSO at Asan Medical Center, Seoul, Korea, from 2010 to 2014. From 2013, all cases were examined according to the Sectioning and Extensively Examining the Fimbria (SEE/FIM) protocol and underwent immunohistochemically staining. RRSO was performed in 63 patients, 27 in 2010 to 2012 and 36 in 2013 to 2014.
RESULTS
The median age at RRSO was 46.5 years (range, 32 to 73 years). Occult invasive cancer was detected in eight patients, of ovarian origin in five and of tubal origin in three. All occult invasive cancer cases with metastasis were detected in patients older than 40 years. Of the 36 patients from the 2013 to 2014 cohort, seven showed p53 overexpression, one showed Ki-67 overexpression, two showed serous tubal intraepithelial carcinoma, and three showed occult cancer. The detection rate of precursor lesions or cancer was 36.1% (13/36). In the analysis according to age, precursor lesions were more common in BRCA1 mutation carriers younger than 40 years old (66.7% vs. 20.0%). In BRCA2 mutation carriers, precursor lesions were only detected in those older than 40 years of age, indicating the possible faster occurrence of precursor lesions in BRCA1 mutation carriers.
CONCLUSION
Many patients still tend to delay RRSO until after they are 40 years old. Our findings support the significance of RRSO before the age of 40 in germline BRCA mutation carriers.

Keyword

BRCA; Risk-Reducing Salpingo-Oophorectomy; Serous Tubal Intraepithelial Carcinoma

MeSH Terms

Adenocarcinoma/pathology
Adult
Age Factors
Aged
Breast Neoplasms/*genetics/*pathology
Chi-Square Distribution
Fallopian Tube Neoplasms/genetics/pathology
Female
*Genes, BRCA1
*Genes, BRCA2
Genetic Predisposition to Disease
Humans
Middle Aged
Mutation
Ovarian Neoplasms/*genetics/*pathology
*Ovariectomy
Regression Analysis
Retrospective Studies
Risk Factors