Pathologic findings at risk-reducing salpingo-oophorectomy (RRSO) in germline BRCA mutation carriers with breast cancer: significance of bilateral RRSO at the optimal age in germline BRCA mutation carriers.
OBJECTIVE
Most BRCA1/2 carriers do not undergo risk-reducing salpingo-oophorectomy (RRSO) by the recommended age. This study aimed to find the incidence of precursor lesions and cancer after RRSO.


METHODS
We retrospectively reviewed breast cancer patients identified as BRCA mutation carriers who underwent RRSO at Asan Medical Center, Seoul, Korea, from 2010 to 2014. From 2013, all cases were examined according to the Sectioning and Extensively Examining the Fimbria (SEE/FIM) protocol and underwent immunohistochemically staining. RRSO was performed in 63 patients, 27 in 2010 to 2012 and 36 in 2013 to 2014.


RESULTS
The median age at RRSO was 46.5 years (range, 32 to 73 years). Occult invasive cancer was detected in eight patients, of ovarian origin in five and of tubal origin in three. All occult invasive cancer cases with metastasis were detected in patients older than 40 years. Of the 36 patients from the 2013 to 2014 cohort, seven showed p53 overexpression, one showed Ki-67 overexpression, two showed serous tubal intraepithelial carcinoma, and three showed occult cancer. The detection rate of precursor lesions or cancer was 36.1% (13/36). In the analysis according to age, precursor lesions were more common in BRCA1 mutation carriers younger than 40 years old (66.7% vs. 20.0%). In BRCA2 mutation carriers, precursor lesions were only detected in those older than 40 years of age, indicating the possible faster occurrence of precursor lesions in BRCA1 mutation carriers.


CONCLUSIONS
Many patients still tend to delay RRSO until after they are 40 years old. Our findings support the significance of RRSO before the age of 40 in germline BRCA mutation carriers.
Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Young Jae
http://orcid.org/0000-0001-6557-2454
YJ
Lee
Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. swhlee@amc.seoul.kr.
Shin Wha
http://orcid.org/0000-0002-5088-1905
SW
Lee
Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Kyu Rae
KR
Kim
Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Kyung Hae
http://orcid.org/0000-0002-1580-7224
KH
Jung
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Jong Won
http://orcid.org/0000-0001-7875-1603
JW
Lee
Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Yong Man
http://orcid.org/0000-0003-3225-5748
YM
Kim
D000230:Adenocarcinoma / Q000473:pathology; D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics* / Q000473:pathology*; D016009:Chi-Square Distribution; D005185:Fallopian Tube Neoplasms / Q000235:genetics / Q000473:pathology; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D006801:Humans; D008875:Middle Aged; D009154:Mutation; D010051:Ovarian Neoplasms / Q000235:genetics* / Q000473:pathology*; D010052:Ovariectomy; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors
BRCA; Risk-Reducing Salpingo-Oophorectomy; Serous Tubal Intraepithelial Carcinoma
Gynecol Oncol. 2011 Jun 1;121(3):472-6
21411127
Maturitas. 2011 Nov;70(3):261-5
21893388
Int J Gynecol Cancer. 2009 Aug;19(6):1029-36
19820364
J Clin Oncol. 2014 Oct 10;32(29):3275-83
25199754
J Cancer Res Clin Oncol. 2009 Nov;135(11):1593-9
19499246
J Clin Oncol. 2008 Mar 10;26(8):1331-7
18268356
Breast Cancer Res Treat. 2014 Nov;148(2):397-406
25311111
J Clin Oncol. 2010 Aug 1;28(22):3570-6
20606085
J Clin Oncol. 2007 Sep 1;25(25):3985-90
17761984
J Oncol. 2010;2010:126295
20445756
Menopause. 2014 Jul;21(7):763-8
24253485
Am J Obstet Gynecol. 2011 Jan;204(1):19.e1-6
20619389
Lancet Oncol. 2006 Oct;7(10):821-8
17012044
J Clin Oncol. 2005 Jan 1;23(1):127-32
15625367
Obstet Gynecol. 2009 May;113(5):1027-37
19384117
Am J Surg Pathol. 2006 Feb;30(2):230-6
16434898
Gynecol Oncol. 2006 Jan;100(1):58-64
16137750
Cancer Prev Res (Phila). 2012 Jun;5(6):847-54
22556202
Front Oncol. 2014 Jan 23;4:5
24478985
Gynecol Oncol. 2014 Sep;134(3):492-7
25026639
Eur J Cancer. 2009 Jan;45(1):82-9
19008092
Mod Pathol. 2009 Sep;22(9):1133-8
19543244
Gynecol Oncol. 2014 Feb;132(2):428-33
24355485
Eur J Cancer. 2015 Feb;51(3):400-8
25532426