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Rate of Cancer Detection at Risk-Reducing Salpingo-Oophorectomy

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Key Points

  • Clinically occult cancers were found in 2.6% of high-risk women undergoing risk-reducing salpingo-oophorectomy.
  • Postmenopausal status, BRCA1/2 mutation, and abnormal CA-125 or transvaginal ultrasound results were predictive of ovarian/tubal neoplasm at reducing salpingo-oophorectomy.

In a study reported in the Journal of Clinical Oncology, Sherman et al found occult cancers in 2.6% of high-risk women undergoing risk-reducing salpingo-oophorectomy.

Study Details

The study involved 966 asymptomatic high-risk women age ≥ 30 years who underwent risk-reducing salpingo-oophorectomy in the surgical arm of the Gynecologic Oncology Group (GOG) 0199 trial (also known as the National Ovarian Cancer Prevention and Early Detection Study). The women underwent preoperative cancer antigen 125 (CA-125) serum testing and transvaginal ultrasound. Among all patients, 33% had BRCA1 mutation, 24% had BRCA2 mutation (with two patients [0.2%] being positive for both), and 42% were not BRCA mutation carriers.

Incidence of Cancers

Invasive or intraepithelial ovarian (n = 11), tubal (n = 9), or peritoneal (n = 5) neoplasms were found in 25 patients (2.6%), including 4.6% of BRCA1 mutation carriers, 3.5% of BRCA2 carriers, and 0.5% of those without BRCA1/2 mutation (P < .001).

In multivariate analysis, postmenopausal status (odds ratio [OR] = 4.8, 95% confidence interval [CI] = 1.8–13.2), BRCA1/2 mutation (OR = 8.3, 95% CI = 1.9–37.0), and abnormal CA-125 or transvaginal ultrasound results (OR = 13.8, 95% CI = 5.2–36.3) were independent predictors of ovarian/tubal neoplasm at risk-reducing salpingo-oophorectomy. In analysis excluding 27 women with suspicious transvaginal ultrasounds or CA-125 levels > 100 U/mL, BRCA1/2 mutation (OR = 11.3, 95% CI = 1.4–87.9), abnormal baseline CA-125 or transvaginal ultrasound (OR = 6.5, 95% CI = 1.8-24.3), and menopausal status (OR = 4.0, 95% CI = 1.2-13.3) were predictive of neoplasm at risk-reducing salpingo-oophorectomy.

No cancers were found among BRCA mutation noncarriers with normal baseline transvaginal ultrasound and CA-125 findings. Among carriers, older age and postmenopausal status were associated with a similar slightly increased risk (OR = 1.1, 95% CI =1.0–1.1).

The investigators concluded: “Clinically occult cancer was detected among 2.6% of high-risk women undergoing [risk-reducing salpingo-oophorectomy]. BRCA1/2 mutation, postmenopausal status, and abnormal preoperative CA-125 and/or [transvaginal ultrasound] were associated with cancer detection at [risk-reducing salpingo-oophorectomy]. These data can inform management decisions among women at high risk of ovarian/tubal cancer.”

Mark H. Greene, MD, of the National Cancer Institute, is the corresponding author for the Journal of Clinical Oncology article.

The study was supported by the National Cancer Institute. Noah D. Kauff, MD, reported a consultant or advisory role with Pfizer and expert testimony for Pfizer.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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