Search our Database of Scientific Publications and Authors

I’m looking for a

    Details and Download Full Text PDF:
    Prophylactic salpingectomy and delayed oophorectomy as an alternative for BRCA mutation carriers.

    Obstet Gynecol 2013 Jan;121(1):14-24
    University of British Columbia and BC Cancer Agency, Vancouver, British Columbia, Canada.
    Objective: Prophylactic bilateral salpingo-oophorectomy is advised for women with BRCA mutations, but there are adverse consequences of premature menopause. The majority of BRCA-associated ovarian cancers appear to arise in the fallopian tube; therefore, salpingectomy may be an alternative to bilateral salpingo-oophorectomy. We compared the costs and benefits of salpingectomy with bilateral salpingo-oophorectomy among BRCA mutation carriers.

    Methods: We developed a Markov Monte Carlo simulation model to compare three strategies for risk reduction in women with BRCA mutations: 1) bilateral salpingo-oophorectomy; 2) bilateral salpingectomy; and 3) bilateral salpingectomy with delayed oophorectomy. Net health benefits were measured in years-of-life expectancy and quality-adjusted life-year expectancy, and the primary outcome was the incremental cost-effectiveness ratio. The model estimated the number of future breast and ovarian cancers and cardiovascular deaths attributed to premature menopause with each strategy.

    Results: Bilateral salpingo-oophorectomy was associated with the lowest cost and highest life expectancy compared with the other two strategies. When quality-of-life measures were included, salpingectomy followed by delayed oophorectomy yielded the highest quality-adjusted life expectancy with incremental cost-effectiveness ratios of $37,805 and $89,680 per quality-adjusted life-year for BRCA1 and BRCA2, respectively, relative to salpingectomy alone. Bilateral salpingo-oophorectomy yielded the lowest number of future breast and ovarian cancers compared with the other two strategies.

    Conclusion: Bilateral salpingo-oophorectomy offers the greatest risk reduction for breast and ovarian cancer among BRCA mutation carriers. However, when considering quality-adjusted life expectancy, bilateral salpingectomy with delayed oophorectomy is a cost-effective strategy and may be an acceptable alternative for those unwilling to undergo bilateral salpingo-oophorectomy.
    PDF Download - Full Text Link
    ( Please be advised that this article is hosted on an external website not affiliated with PubFacts.com)
    Source Status
    http://dx.doi.org/http://10.1097/AOG.0b013e3182783c2fDOI ListingPossible

    Similar Publications

    Cost-effectiveness of preventive strategies for women with a BRCA1 or a BRCA2 mutation.
    Ann Intern Med 2006 Mar;144(6):397-406
    Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Joseph L. Mailman School of Public Health, Columbia University, and New York Presbyterian Hospital, New York, New York 10032, USA.
    Background: For BRCA1 or BRCA2 mutation carriers, decision analysis indicates that prophylactic surgery or chemoprevention leads to better survival than surveillance alone.

    Objective: To evaluate the cost-effectiveness of the preventive strategies that are available to unaffected women carrying a single BRCA1 or BRCA2 mutation with high cancer penetrance.

    Design: Markov modeling with Monte Carlo simulations and probabilistic sensitivity analyses. Read More
    Prophylactic mastectomy with immediate reconstruction combined with simultaneous laparoscopic salpingo-oophorectomy via a transmammary route: a novel surgical approach to female BRCA-mutation carriers.
    Arch Gynecol Obstet 2014 Jun 4;289(6):1325-30. Epub 2014 Jan 4.
    1st Department of Obstetrics and Gynecology, Campus Innenstadt, Ludwig-Maximilians-University Munich, Maistrasse 11, 80337, Munich, Germany.
    Introduction: Breast reconstruction with salpingo-oophorectomy can easily be performed in patients with genetic mutations increasing the risk for mammary and ovarian carcinoma. However, many patients are skeptical about having several surgeries, as they may result in additional anesthesiological risks as well as multiple visible scars. Therefore, the purpose of this study was to evaluate the feasibility of prophylactic mastectomy and breast reconstruction combined with simultaneous transmammary salpingo-oophorectomy for BRCA carriers. Read More
    Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation.
    N Engl J Med 2002 May 20;346(21):1609-15. Epub 2002 May 20.
    Clinical Genetics Service, Memorial Sloan-Kettering Cancer Center, New York 10021, USA.
    Background: Risk-reducing salpingo-oophorectomy is often considered by carriers of BRCA mutations who have completed childbearing. However, there are limited data supporting the efficacy of this approach. We prospectively compared the effect of risk-reducing salpingo-oophorectomy with that of surveillance for ovarian cancer on the incidence of subsequent breast cancer and BRCA-related gynecologic cancers in women with BRCA mutations. Read More
    Outcome of risk-reducing salpingo-oophorectomy in BRCA carriers and women of unknown mutation status.
    BJOG 2011 Jun 10;118(7):814-24. Epub 2011 Mar 10.
    Department of Gynaecological Oncology, EGA Institute for Women's Health, UCL, London, UK.
    Objective: To compare surgical outcomes and occult cancer rates at risk-reducing salpingo-oophorectomy in BRCA carriers and high-risk women who had not undergone genetic testing.

    Design: Prospective cohort study.

    Setting: Tertiary high-risk familial gynaecological cancer clinic. Read More