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    Surgical options for reducing risk in BRCA mutation carriers


    Interval salpingectomy in BRCA mutation carriers

    Because the Fallopian tube is believed to be the site of origin of the majority of ovarian serous cancers, interval salpingectomy has been proposed as an attractive risk-reducing surgery to preserve ovarian function and postpone the risks of surgically induced premature menopause in young BRCA mutation carriers.38,39 Small series have shown that the procedure is feasible and does not compromise ovarian function in the short term.40 However, several issues regarding interval salpingectomy remain unresolved with regard to long-term outcomes and its efficacy in reducing cancer risk in BRCA mutation carriers.41

    Fifteen percent to 30% of serous ovarian cancers show no evidence of Fallopian tube mucosal involvement, suggesting that the cancer may have originated on the ovarian surface epithelium or from ovarian cortical inclusion cysts. Interval salpingectomy would offer little prospect of risk-reduction against cancers that develop along this pathway.42 A second surgery to remove the ovaries presents additional risks and concern also exists about whether interval salpingectomy might provide BRCA mutation carriers with a false sense of security about their risk of cancer, leading them to significantly delay or reject definitive oophorectomy. Finally, there is no evidence to date demonstrating that interval salpingectomy reduces cancer risk.

    Ilana Cass, MD
    Dr. Cass is an Assistant Professor of Obstetrics and Gynecology, UCLA/Cedars-Sinai Medical Center, Los Angeles, Calif.


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