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Gynecol Oncol. 2018 Jul;150(1):85-91. doi: 10.1016/j.ygyno.2018.05.011. Epub 2018 May 21.

Age-specific ovarian cancer risks among women with a BRCA1 or BRCA2 mutation.

Author information

1
Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
2
International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland.
3
Women's Cancer Program, Cedars Sinai Medical Center, Los Angeles, CA, USA.
4
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, ON, Canada.
5
Inherited Cancer Research Group, The Norwegian Radium Hospital, Department for Medical Genetics; and Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
6
Department of Preventive Medicine and Public Health, Creighton University School of Medicine, Omaha, NE, USA.
7
Department of Obstetrics and Gynecology and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
8
Division of Human Genetics, the Ohio State University Medical Center, Comprehensive Cancer Center, Columbus, OH, USA.
9
Division of Biomarkers of Early Detection and Prevention, Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA.
10
Beth Israel Deaconess Medical Center, Boston, MA, USA.
11
Toronto-Sunnybrook Regional Cancer Center, Toronto, ON, Canada.
12
Program in Cancer Genetics, Department of Oncology and Human Genetics, McGill University, Montréal, QC, Canada.
13
London Health Sciences, London, ON, Canada.
14
Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
15
Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Electronic address: steven.narod@wchospital.ca.

Abstract

OBJECTIVES:

For women at high risk of developing ovarian cancer, it is important to provide an accurate recommendation for the optimal age for preventive surgery in order to maximize the preventative effect while delaying symptoms associated with early surgical menopause. The goal of the current study was to estimate age-specific incidence rates of ovarian cancer among women with a BRCA1 or BRCA2 mutation.

METHODS:

From our international registry, we identified 5689 women with no previous diagnosis of ovarian or fallopian tube cancer or preventive oophorectomy. Women were followed from the date of completion of the baseline questionnaire until either a diagnosis of ovarian or fallopian tube cancer, prophylactic oophorectomy, death or last follow-up. The annual and cumulative incidence rates of ovarian cancer were estimated.

RESULTS:

Over a mean follow-up period of 4.7 years (ranges 0-22.6), 195 incident ovarian or fallopian tube cancers were diagnosed (169 [86%] ovarian cancers, 22 [11%] fallopian tube cancers and four [2%] cancers that involved both the ovaries and fallopian tubes). Of these, 45 (23%) cancers were diagnosed at preventive surgery (occult cancers). The cumulative risk of ovarian cancer to age 80 was 49% for BRCA1 and 21% for BRCA2 mutation carriers. The mean age at diagnosis was 51.3 years (ranges 33-84) among women with a BRCA1 mutation and 61.4 years (ranges 44-80) among women with a BRCA2 mutation.

CONCLUSION:

Based on a cumulative risk of 0.55% to age 35 for BRCA1 mutation carriers and of 0.56% to age 45 for BRCA2 mutation carriers, we recommend bilateral salpingo-oophorectomy before age 40, but ideally by age 35, for women with a BRCA1 mutation and by age 45 for those with a BRCA2 mutation to maximize prevention and to minimize adverse effects.

KEYWORDS:

Age-specific risk; BRCA1; BRCA2; Ovarian cancer

PMID:
29793803
DOI:
10.1016/j.ygyno.2018.05.011
[Indexed for MEDLINE]

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