Research from the Society of Gynecologic Oncology 2013
New Research from the Society of Gynecologic Oncology
by Lisa Rezende, PhD
The annual meeting of the Society of Gynecologic Oncology (SGO) was held March 9-12 in Los Angeles. Several research studies relevant to the hereditary breast and ovarian cancer (HBOC) community were presented. You can view a list of abstracts from the presentations here.
- A study from Dr. Lu and colleagues at MD Anderson Cancer Center in Houston examined ovarian, fallopian tube, and primary peritoneal cancers from women with known mutations in either BRCA1 or BRCA2. Experts classify invasive epithelial ovarian cancer into subtypes based on their appearance. Most common is serous ovarian cancer that is often seen in hereditary breast and ovarian cancers that run in families. Other types include mucinous, endometrioid, and clear cell ovarian cancers. Some cancers, which don’t resemble any of these, are called undifferentiated. Using this method of classification, previous studies showed that the majority of ovarian, fallopian tube, and peritoneal cancers from BRCA1 or BRCA2 mutation carriers are categorized as serous carcinomas. In this new study of 180 patients with confirmed BRCA1 or BRCA2 mutations, the authors reported that approximately 10% of the ovarian, fallopian tube, or primary peritoneal cancers were not serous cancers. Based on these results, the authors caution that BRCA testing should not be limited to patients with the serous cancer subtype.
- Removal of the fallopian tubes and ovaries, known as risk-reducing salpingo-oophorectomy, has been shown to reduce not only the risk of gynecological cancers, but also the risk of breast cancer in women with mutations in BRCA1 or BRCA2 genes when the procedure is performed prior to menopause. A new study by Dr. Kauff at Memorial Sloan-Kettering Cancer Center in New York reported that risk-reducing salpingo-oophorectomy may also reduce the risk of breast cancer in BRCA1 or BRCA2 mutation carriers who have already undergone menopause. The study followed 199 post-menopausal BRCA mutation carriers and found that risk-reducing salpingo-oophorectomy appeared to confer a 57% reduction in breast cancer risk in women who had undergone menopause before surgery —although the ovaries stop producing estrogen and progesterone after natural menopause, they continue to produce some hormones, including testosterone. This could explain why RRSO after menopause still has protective effects against breast cancer.
- Recent evidence that many BRCA-associated ovarian cancers actually originate in the fallopian tubes has piqued interest for prophylactic removal of fallopian tubes only (salpingectomy) in premenopausal BRCA1 or BRCA2 mutation carriers. FORCE conducted an online survey of 204 premenopausal women with BRCA mutations who had neither ovarian cancer or a risk-reducing removal of fallopian tubes and ovaries (salpingo-oophorectomy). Thirty-four percent of women surveyed said they would definitely be interested in a study of salpingectomy; approximately 83% of these women cited the possibility of reducing ovarian cancer risk without menopause as their motivation to participate. On the other hand, approximately 30% of women said they would not be interested in such a study, citing concerns about surgical complications, the possibility of ovarian damage, and potential cost. Notably, 68% of respondents indicated that the possibility that the experimental surgery might not lower their risk for ovarian cancer would be acceptable when they considered whether or not to participate in such a study. Based on these findings, study authors suggest that there would be enough patient interest in the HBOC community to begin a clinical trial of risk-reducing salpingectomy.
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