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Risk factors identified for occult cancers found at risk-reducing salpingo-oophorectomy

Key clinical point: Older postmenopausal women, BRCA 1/2 mutation carriers, and women with abnormal cancer 125 (CA-125) serum levels or transovarian ultrasound results were significantly more likely to have occult invasive cancers diagnosed when they underwent RRSO.

Major finding: Significant predictors of invasive cancer at the time of RRSO included BRCA 1/2 mutations (odds ratio, 11.3; 95% confidence interval, 1.4 to 87.9), abnormal baseline CA-125 or transovarian ultrasound results (OR, 6.5; 95% CI, 1.8-24.3), and postmenopausal status (OR, 4.0; 95% CI, 1.2-13.3).

Data source: Analysis of data from 996 high-risk women who chose RRSO as part of a nonrandomized prospective clinical trial (Gynecologic Oncology Group 0199, or GOG 0199) of the National Ovarian Cancer Prevention and Early Detection Study.

Disclosures: The National Cancer Institute funded the study. One coauthor reported having served as a paid consultant for Pfizer, and the rest reported no conflicts of interest.


 

FROM JOURNAL OF CLINICAL ONCOLOGY

References

Older, postmenopausal women with BRCA1 or BRCA2 mutations and abnormal baseline tests were most likely to have occult cancers at risk-reducing salpingo-oophorectomy, investigators reported online in the Journal of Clinical Oncology.

Pathology results showed that 2.6% of women who underwent the surgery had occult ovarian, tubal, or peritoneal cancers, including 4.6% of BRCA1 mutation carriers, 3.5% of BRCA2 carriers, and 0.5% of women who lacked either mutation, said Dr. Mark Sherman of the National Cancer Institute and his associates. These rates resembled findings from other recent studies, the researchers said.

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2.6% of women who underwent the surgery had occult ovarian, tubal, or peritoneal cancers, including 4.6% of BRCA1 mutation carriers, 3.5% of BRCA2 carriers, and 0.5% of women who lacked either mutation.

The investigators studied 966 high-risk women who chose risk-reducing salpingo-oophorectomy (RRSO) as part of a nonrandomized prospective clinical trial (Gynecologic Oncology Group 0199, or GOG 0199) of the National Ovarian Cancer Prevention and Early Detection Study. Cancers rates were similar to those from other recent analyses, the researchers reported. Women were more likely to have occult cancer at RRSO if they had BRCA1/2 mutations (odds ratio, 11.3; 95% confidence interval, 1.4-87.9), abnormal baseline transovarian ultrasound or CA-125 levels (OR, 6.5; 95% CI, 1.8-24.3), or were postmenopausal (OR, 4.0; 95% CI, 1.2-13.3), the investigators wrote (J. Clin. Onc. 2014 Sept. 8 [doi:10.1200/JCO.2013.54.1987]).

All the women with occult cancers were at least 42 years old, and their median age was more than 52 years, compared with 47 years for surgical patients who had benign pathology (P less than .001), said the investigators. Postmenopausal women had an almost fourfold greater cancer rate than that of premenopausal women (P less than .003), they added.

But more than half of patients with occult ovarian or tubal cancer had serous tubal intraepithelial cancer or stage I or II invasive cancer, suggesting a better prognosis than that for patients with overt signs of cancer at surgery, said the researchers.

The National Cancer Institute funded the study. One coauthor reported having served as a paid consultant for Pfizer and the rest reported no conflicts of interest.

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