Project A: Histopathological outcome in prophylactic bilateral salpingo-oophorectomy

Department of Epidemiology and Gynaecology
Coordinators: GH de Bock, MJE Mourits

Breast cancer is the most common type of cancer in women and the life time risk of developing breast cancer for individual women in the Netherlands is approximately 12-13%. Women from breast cancer families have an increased risk and for women with a proven BRCA1 or BRCA2 mutation, this life time risk can go up to 80%. Women with a BRCA1 or BRCA2 mutation also have a very high risk of developing ovarian cancer, which is raised to 45% and 11% life time in BRCA1 and BRCA2 mutation carriers respectively, compared to 1.4% in the population.

Until recently, ovarian cancer screening by annual transvaginal ultrasonography and evaluation of serum CA125 was considered effective for early stage diagnosis. However, in several (retrospective) series it has been shown ineffective in detecting early stage ovarian cancer. The only effective and currently available risk reducing strategy is prophylactic bilateral salpingo-oophorectomy (pBSO). Removal of the ovaries and fallopian tubes is highly effective and reduces the gynaecological cancer risk in BRCA mutation carriers by 95%.

Several reports have been published about surgical outcome after an oophorectomy for benign or malignant pathology of the ovaries. Generally, laparoscopic surgery of the ovaries is accompanied by a low complication rate, a low conversion rate, short hospital stay and fast recovery. It has been mentioned that about 3-10% of the women with a BRCA1/2 mutation are diagnosed with an occult ovarian or tubal malignancy at the time of pBSO. A few authors report a 10 times higher incidence of tubal cancers in BRCA 1 carriers than in the general population. Tubal cancers are hard to distinguish from ovarian cancers in very advanced cancer cases. However, occult tubal cancers have been described after thorough investigation of the whole tube after pBSO. 

The aim of the current proposal is to do a 2-weeks literature search to get an overview of the histopathological outcomes in prophylactic bilateral salpingo-oophorectomy. The method is a systematic search in the literature according to the principles of Evidence Based Medicine.