Outcome of surveillance and prophylactic salpingo-oophorectomy in asymptomatic women at high risk for ovarian cancer.
OBJECTIVE
Women at high risk of ovarian cancer are currently offered two options: either surveillance or prophylactic bilateral salpingo-oophorectomy. The efficacy and outcome of surveillance remain unclear.


METHODS
We performed a retrospective study. Between 1994 and 2000, we screened 383 high-risk women, of which 152 were BRCA1/2 mutation carriers. Surveillance consisted of annual gynecological examination, transvaginal ultrasound, and serum CA125 measurement. Exploratory or prophylactic surgery was performed in selected cases.


RESULTS
There were no screen-detected primary ovarian cancers. Abnormal results at surveillance were observed in 74 (19.3%) of women; in 47 (63.5%), the abnormalities disappeared spontaneously. Exploratory surgery was performed in 20 (27.0%) women in whom one malignancy was found (metastatic breast cancer in the ovary). A rising CA125 value prompted further (non-surgical) evaluation in three women with a history of breast cancer: recurrent breast cancer was diagnosed in two women; in the third, a chondrosarcoma was found. 133 women opted for prophylactic bilateral salpingo-oophorectomy, whereby two unexpected malignancies were found (fallopian tube cancer and metastatic breast cancer). One interval primary ovarian cancer occurred, presenting as papillary serous carcinoma of the peritoneum 14 months after prophylactic bilateral salpingo-oophorectomy. Complications of prophylactic surgery were encountered in 15 (11.5%) women.


CONCLUSIONS
Ovarian cancer surveillance has limited sensitivity, and a high number of false positive findings. This can lead to unnecessary surgical interventions, possibly resulting in surgery-related complications. It is important to inform high-risk women of these limitations. For now, prophylactic bilateral salpingo-oophorectomy remains the optimal risk-reducing strategy for women at high risk.
Meeuwissen
Paul A M
PA
Family Cancer Clinic, The Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Erasmus University Medical Centre Rotterdam, Room H585, Dr Molewaterplein 40, 3000 CC Rotterdam, The Netherlands.
Seynaeve
Caroline
C
Brekelmans
Cecile T M
CT
Meijers-Heijboer
Hanne J
HJ
Klijn
Jan G M
JG
Burger
Curt W
CW
D000328:Adult; D018394:CA-125 Antigen / Q000097:blood; D015331:Cohort Studies; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D018095:Germ-Line Mutation; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000097:blood / Q000000981:diagnostic imaging / Q000235:genetics / Q000517:prevention & control*; D010052:Ovariectomy / Q000379:methods; D010053:Ovary / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography
D018394:CA-125 Antigen