In a prospective cohort study reported in JAMA Oncology, Shu et al found that risk for serous/serous-like endometrial carcinoma appeared to be increased after risk-reducing salpingo-oophorectomy (RRSO) without hysterectomy in women harboring the BRCA1 mutation. The overall risk of uterine cancer was not increased. Noah D. Kauff, MD, of the Duke Cancer Institute, Duke University Health System, is the corresponding author of the JAMA Oncology article.
The study included 1,083 women with BRCA1 (n = 627) or BRCA2 mutation (n = 453) or both (n = 3) identified between January 1995 and December 2011 at 9 centers in the United States and United Kingdom who had undergone RRSO without prior or concomitant hysterectomy. Risk of uterine cancer was compared with that expected from the Surveillance, Epidemiology, and End Results database. Women underwent RRSO at a median age of 45.6 years.
Participants were followed for a median of 5.1 years. A total of 8 uterine cancers were observed vs 4.3 expected (observed-to-expected ratio = 1.9, P = .09). According to the subtype, there was no increased risk for endometrioid endometrial carcinoma or sarcoma. Serous/serous-like endometrial carcinoma occurred in 5 women at 7.2 to 12.9 years after RRSO, including 4 with BRCA1 mutation (vs 0.18 expected, ratio = 22.2, P < .001) and 1 with BRCA2 mutation (vs 0.16 expected, ratio = 6.4, P = .15).
The investigators concluded: “Although the overall risk for uterine cancer after RRSO was not increased, the risk for serous/serous-like endometrial carcinoma was increased in BRCA1[-positive] women. This risk should be considered when discussing the advantages and risks of hysterectomy at the time of RRSO in BRCA1[-positive] women.”
The study was supported by the Department of Defense Ovarian Cancer Research Program, National Institutes of Health, National Cancer Institute, National Institute for Health Research, Royal Marsden National Health Service Foundation Trust, and others. ■