Hereditary breast and ovarian cancer (HBOC) have cumulative cancer risks of 45% to 65% for breast cancer and 11% to 39% for ovarian cancer by the age of 70 years. Management of these cancers is required in
BRCA1/2 mutation carriers. Regular medical surveillance has been performed for nearly all patients with HBOC in Japan. On the other hand, prophylactic surgery for risk reduction is a widely accepted interventional procedure in the United States and Europe. Risk reducing salpingo-oophorectomy (RRSO) can decrease the incidence of breast cancers, as well as ovarian and tubal cancers. RRSO also effectively reduces total mortality during 5 to 6 years of observation. Therefore, we believe that RRSO is an effective option for
BRCA1/2 mutation carriers, and an infrastructure supporting the performance of RRSO should be created in medical institutes in which genetic medicine is performed. In our institute, a working group committee was established in January 2010 after we had experienced a case of advanced ovarian cancer with intra-abdominal dissemination in spite of doing medical surveillance. RRSO was approved by our Institutional Review Board in February 2011 after approval by several related committees. At the time of the last academic meeting (June 2012), 5
BRCA1/2 mutation carriers (mean age, 45.6 years) had been enrolled, all of whom had a history of breast cancer. Four of the 5 patients have a family history of ovarian cancer or intractable cancer such as pancreatic cancer, and they have experience caring for their relatives with difficultto- cure cancers. Therefore, preventing cancer-related death is an urgent concern for them. Their postoperative condition is generally satisfactory. We are planning to submit an application for advanced medical care to the Ministry of Health, Labour and Welfare.
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