Experience of three cases of occult cancer in the series of risk-reducing salpingo-oophorectomy for women with hereditary breast and ovarian cancer

Abstract

Hereditary breast and ovarian cancer (HBOC) is associated with a significantly increased risk of breast and ovarian cancer. Risk-reducing salpingo-oophorectomy (RRSO) has proven to reduce the incidence of ovarian/fallopian tube cancer as well as the cancer-specific and overall mortality. According to the National Comprehensive Cancer Network (NCCN) guidelines, RRSO is generally recommended for women aged 35–40 years with BRCA1 pathogenic mutations, who have already given birth. In patients with BRCA2 pathogenic mutations, RRSO can be delayed until 40–45 years of age.

Of the 78 women who underwent RRSO, occult cancer was observed in three women (3.8%), two were BRCA1 (44 and 73 years old) and one was a BRCA2 (47 years old) pathogenic mutation carrier. Although MRI was performed for these three women one month before RRSO, there was no evidence of malignancy, and serum level of CA-125 was not elevated. These three women were diagnosed with stage I.

The age of all three women diagnosed with ovarian cancer was higher than that recommended in the NCCN guidelines. RRSO at a recommended age in the NCCN guidelines is considered to be appropriate for Japanese women.