title: Prophylactic salpingo-oophorectomy in BRCA1 mutation carriers and postoperative incidence of peritoneal and breast cancers.
abstract: BACKGROUND
  There are no effective methods of diagnosis of early-stage ovarian cancer. Conservative care over patients at high risk of ovarian and breast cancers is ineffective. Prophylactic surgery is considered the best prophylaxis among BRCA1/BRCA2 carriers.
  
  
  METHODS
  One hundred ninety-five patients, carriers of one of three most common mutations of the BRCA1 gene (Am J Hum Genet: 66: (6)1963-1968, 2000) in the Polish population (5382insC, 4153delA and C61G), who undergone prophylactic salpingo-oophorectomy. The study group consisted of consecutive mutation carriers living in Poland, in the West Pomeranian province. Histopathological examination of the surgical material failed to reveal presence of malignancy.
  
  
  RESULTS
  During follow-up we diagnosed two peritoneal cancers and 14 breast cancers. Diagnosis of breast cancer before prophylactic surgery increased the risk of peritoneal cancer almost three times. Time from diagnosis of breast cancer to prophylactic surgery increased the risk of peritoneal cancer after prophylactic surgery. This was strongly expressed (HR = 5.0; p = 0.030) in cases of over five-year-long delay in prophylactic surgery. Diagnosis of breast cancer before prophylactic surgery correlated with the risk of death (p = 0.00010). Presence of 5382insC mutation decreased and C61G mutation increased the risk of peritoneal cancer (p = 0.049 vs. p = 0.013).
  
  
  CONCLUSIONS
  Occurrence of primary peritoneal cancer after prophylactic surgery is similar to that reported in international literature. Primary breast cancer occurred less often than in international literature. We suspect that the risk of development of breast cancer among BRCA1 carriers undergoing prophylactic surgery can differ in a population. The next goal should be to study the molecular basis for the risk of development of malignancies in any population. Carriers of BRCA1 gene diagnosed with breast cancer should undergo prophylactic surgery within five years from the diagnosis of breast cancer.
authors.affiliation: Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, SPSK-2, 70-111 Szczecin Al. Powstańców Wielkopolskich 72, Szczecin, Poland. nbz@list.pl.
authors.forename: Janusz
authors.initials: J
authors.lastname: Menkiszak
authors.affiliation: Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, SPSK-2, 70-111 Szczecin Al. Powstańców Wielkopolskich 72, Szczecin, Poland. achudeckaglaz@icloud.com.
authors.forename: Anita
authors.initials: A
authors.lastname: Chudecka-Głaz
authors.affiliation: Department of Genetics and Pathology; International Hereditary Cancer Center, Pomeranian Medical University, Al. Powstańców Wielkopolskich 72, 70-111, Szczecin, Poland. jgron@sci.pum.edu.pl.
authors.forename: Jacek
authors.initials: J
authors.lastname: Gronwald
authors.affiliation: Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, SPSK-2, 70-111 Szczecin Al. Powstańców Wielkopolskich 72, Szczecin, Poland. anetac@data.pl.
authors.forename: Aneta
authors.initials: A
authors.lastname: Cymbaluk-Płoska
authors.affiliation: Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, SPSK-2, 70-111 Szczecin Al. Powstańców Wielkopolskich 72, Szczecin, Poland. a.celewicz@gmail.com.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Celewicz
authors.affiliation: Department of the Clinical Oncology the West Pomeranian Centre of the Oncology in Szczecin, ul. Strzałowska 22, 71-730, Szczecin, Poland. mary.karbag24@interia.pl.
authors.forename: Maria
authors.initials: M
authors.lastname: Świniarska
authors.affiliation: Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, SPSK-2, 70-111 Szczecin Al. Powstańców Wielkopolskich 72, Szczecin, Poland. wezowska.malgorzata@gmail.com.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Wężowska
authors.affiliation: Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, SPSK-2, 70-111 Szczecin Al. Powstańców Wielkopolskich 72, Szczecin, Poland. rysio11@wp.pl.
authors.forename: Ryszard
authors.initials: R
authors.lastname: Bedner
authors.affiliation: Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, SPSK-2, 70-111 Szczecin Al. Powstańców Wielkopolskich 72, Szczecin, Poland. zielinska.dorota@gmail.com.
authors.forename: Dorota
authors.initials: D
authors.lastname: Zielińska
authors.affiliation: Department of Gynecological Surgery and Gynecological Oncology of Adults and Adolescents, Pomeranian Medical University, SPSK-2, 70-111 Szczecin Al. Powstańców Wielkopolskich 72, Szczecin, Poland. pola_21t@wp.pl.
authors.forename: Paulina
authors.initials: P
authors.lastname: Tarnowska
authors.affiliation: Radiation Oncology Department, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute Cracow Branch, Garncarska 11, 31-115, Kraków, Poland. jerzy@jakubowicz.pl.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Jakubowicz
authors.affiliation: Department of Gynecologic Oncology, Centre of Oncology, Maria Sklodowska-Curie Memorial Institute, Cracow Branch, Garncarska 11, 31-115, Kraków, Poland. zkojs@interia.pl.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kojs
mesh_terms: D000328:Adult; D000368:Aged; D019313:BRCA1 Protein / Q000235:genetics*; D001943:Breast Neoplasms / Q000453:epidemiology / Q000235:genetics*; D005260:Female; D006579:Heterozygote; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D009154:Mutation; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control*; D010052:Ovariectomy; D010534:Peritoneal Neoplasms / Q000453:epidemiology / Q000235:genetics*; D011184:Postoperative Period; D012307:Risk Factors; D058994:Salpingectomy
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human