Synapse - Risk-reducing bilateral salpingo-oophorectomy for ovarian cancer: A review and clinical guide for hereditary predisposition genes

Risk-reducing bilateral salpingo-oophorectomy for ovarian cancer: A review and clinical guide for hereditary predisposition genes Review

Authors:	Liu, Y. L.; Breen, K.; Catchings, A.; Ranganathan, M.; Latham, A.; Goldfrank, D. J.; Grisham, R. N.; Long Roche, K.; Frey, M. K.; Chi, D. S.; Abu-Rustum, N.; Aghajanian, C.; Offit, K.; Stadler, Z. K.
Review Title:	Risk-reducing bilateral salpingo-oophorectomy for ovarian cancer: A review and clinical guide for hereditary predisposition genes
Abstract:	Pathogenic germline variants underlie up to 20% of ovarian cancer (OC) and are associated with varying degrees of risk for OC. For mutations in high-penetrance genes such as BRCA1/2, the role of risk-reducing bilateral salpingo-oophorectomy (RRSO) in cancer prevention is well-established and improves mortality. However, in moderate-penetrance genes where the degree of risk for OC is less precisely defined, the role of RRSO is more controversial. Although national guidelines have evolved to incorporate gene-specific recommendations, studies demonstrate significant variations in practice. Given this, our multidisciplinary group has reviewed the available literature on risk estimates for genes associated with OC, incorporated levels of evidence, and set thresholds for consideration of RRSO. We found that the benefit of RRSO is well-established for pathogenic variants in BRCA1/2 as well as BRIP1 and RAD51C/D where the risk of OC is elevated beyond our threshold for RRSO. In PALB2, RRSO is particularly controversial as newer studies consistently demonstrate an increased risk of OC that is dependent on family history, making uniform recommendations challenging. Additionally, new guidelines for Lynch syndrome provide gene-specific risks, questioning the role of RRSO, and even hysterectomy, for MSH6 and PMS2 mutation carriers. Given these uncertainties, shared decision making should be used around RRSO with discussion of individual risk factors, family history, and adverse effects of surgery and premature menopause. Herein, we provide a clinical guide and counseling points. © 2021 by American Society of Clinical Oncology
Journal Title:	JCO Oncology Practice
Volume:	18
Issue:	3
ISSN:	2688-1527
Publisher:	American Society of Clinical Oncology
Date Published:	2022-03-01
Start Page:	201
End Page:	209
Language:	English
DOI:	10.1200/op.21.00382
PUBMED:	34582274
PROVIDER:	scopus
PMCID:	PMC8932494
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85126389528&doi=10.1200%2fOP.21.00382&partnerID=40&md5=dfa2cc3e59c859e56038cdf8619bad7a
Notes:	Review -- Export Date: 1 April 2022 -- Source: Scopus