BRCA1 Carriers Thought At Risk of Serous/Serous-Like Endometrial Carcinoma

Increased risk of serous or serous-like endometrial carcinoma raises question of potential role for hysterectomy after risk-reducing salingo-oophorectomy in women carrying the BRCA1 mutation

medwireNews: Women carrying a deleterious BRCA1 mutation who undergo risk-reducing salpingo-oophorectomy (RRSO) may be at increased risk of developing serous or serous-like endometrial carcinoma, research suggests.

Overall, just eight of 1083 women who underwent RRSO without prior or concomitant hysterectomy developed uterine cancer, giving a nonsignificant observed to expected ratio of 1.9, where the expected rates were derived from the US Surveillance, Epidemiology, and End Results (SEER) database, the researchers report in JAMA Oncology.

Nor was there an increased risk for endometrioid endometrial carcinoma or sarcoma subtypes in the RRSO patient population.

However, four BRCA1-positive patients and one BRCA2-positive patient were diagnosed with pure serous carcinoma or endometrial carcinoma with serous components between 7.2 to 12.9 years after undergoing RRSO. The observed to expected ratio for serous/serous-like endometrial carcinoma in the RRSO population was therefore a significant 14.8, rising to 22.2 for the BRCA1 carriers.

This translated to an estimated risk of between 2.6% and 4.7% up to the age of 70 years for a BRCA1-positive woman undergoing RRSO at age 45 years depending on whether assuming a constant annual risk or relative risk to SEER, the researchers explain.

“Given the similar surgical risks, very low mortality, acceptable costs, and potential protection against serous-like endometrial cancer, if the present results are confirmed by future studies, hysterectomy with bilateral salpingo-oophorectomy may become the preferred risk-reducing surgical approach for BRCA1+ women”, say Noah Kauff, from Duke Cancer Institute in Durham, North Carolina, USA, and co-workers. 

They acknowledge that RRSO alone will remain preferable for women with strong reasons for uterine retention, such as future pregnancy or pelvic adhesion.

“For BRCA1+ women who have already undergone RRSO, the optimal approach is less clear”, they continue. 

“Whether a 25-year risk for serous/ serous-like uterine cancer of 2.6% to 4.7% justifies the risks and costs of a second surgery will need to be addressed by future prospective studies.”

Reference

Shu CA, Pike MC, Jotwani AR, et al. Uterine cancer after risk-reducing salpingo-oophorectomy without hysterectomy in women with BRCA mutations. JAMA Oncol 2016; Advance online publication 30 June. doi:10.1001/jamaoncol.2016.1820

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