title: Clinical management of patients at inherited risk for gynecologic cancer.
abstract: OBJECTIVE
  As more women with an inherited increased risk of gynecologic cancer are identified, the clinician will be challenged to counsel these women on risk-reducing strategies.
  
  
  RESULTS
  Although there are some recent studies that show potential for ovarian cancer surveillance strategies, there remains no definitive evidence that surveillance leads to a stage shift or a reduction in mortality. Recent studies support the following conclusions: first, oral contraceptive use reduces ovarian cancer risk without significantly increasing breast cancer risk, second, salpingo-oophorectomy leads to a reduction in ovarian cancer, breast cancer, and overall mortality for women who are carriers of BRCA1 and BRCA2 mutations, and third, the 'ovarian cancers' associated with BRCA mutations actually include fallopian tube and peritoneal cancer and may have a precursor lesion in the fallopian tube; this observation has prompted the provocative suggestion of removing the fallopian tube to reduce ovarian cancer risk.
  
  
  CONCLUSIONS
  Because of the interplay between the hormonal impact of ovarian function on breast cancer risk, the risk reduction associated with oophorectomy, and the impact of early menopause on other health outcomes, an integrated multidisciplinary approach is required to aid in the increasingly complex decisions faced by women with high inherited risk of developing gynecologic cancers.
authors.affiliation: Division of Gynecologic Oncology, Kaiser Permanente Medical Group, San Francisco, California, USA.
authors.forename: C Bethan
authors.initials: CB
authors.lastname: Powell
mesh_terms: D018890:Chemoprevention; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005817:Genetic Counseling / Q000379:methods*; D020022:Genetic Predisposition to Disease; D005833:Genital Neoplasms, Female / Q000235:genetics* / Q000517:prevention & control*; D006801:Humans; D008962:Models, Theoretical; D009154:Mutation; D010052:Ovariectomy; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D012307:Risk Factors; D040242:Risk Reduction Behavior; D018571:Sentinel Surveillance
chemical_list: D003278:Contraceptives, Oral, Hormonal