Our Summary

This research paper discusses the various strategies to prevent breast cancer in women who are at a high risk of developing it. These women include those with and without specific genetic mutations that increase their risk. The study emphasizes the need for a personalized and multidisciplinary approach to prevention.

The paper talks about preventive therapy using medications like tamoxifen and aromatase inhibitors, which can significantly reduce the risk of breast cancer, even beyond the period of active treatment. It also highlights the under-recognized importance of benign breast disease - non-cancerous conditions of the breast - as an indicator of increased breast cancer risk. Even though these women could greatly benefit from preventive therapy, it is not used as often as it should be.

The study also discusses the role of surgical procedures like Bilateral Risk-Reducing Mastectomy (BRRM) and Bilateral risk-reducing salpingo-oophorectomy, which can substantially cut down the risk of breast cancer in women with high-risk genetic mutations like BRCA.

However, the study concludes that more research is needed to improve risk models, find biomarkers that can predict the benefits of preventive therapy, and develop new preventive treatments.

FAQs

  1. What is bilateral risk-reducing salpingo-oophorectomy and how does it relate to breast cancer prevention?
  2. Which types of women are considered at high risk of developing breast cancer?
  3. How do selective oestrogen receptor modulators (SERMs) like tamoxifen and aromatase inhibitors (AIs) help in reducing breast cancer risk?

Doctor’s Tip

A doctor may tell a patient undergoing salpingo-oophorectomy that the procedure can reduce the risk of developing certain types of cancer, such as ovarian and fallopian tube cancers. They may also recommend discussing with a genetic counselor to determine if there is a hereditary risk for other types of cancer, such as breast cancer, and to consider additional preventative measures if needed. Regular follow-up appointments and screenings may also be recommended to monitor overall health and well-being.

Suitable For

Patients who are typically recommended salpingo-oophorectomy include women with a high risk of developing breast and ovarian cancer, particularly those with germline mutations such as BRCA1 and BRCA2 mutations. This procedure may also be recommended for women with a strong family history of these cancers or other risk factors that increase their likelihood of developing them. Additionally, salpingo-oophorectomy may be recommended for women with certain benign gynecological conditions, such as ovarian cysts or endometriosis, that increase their risk of developing ovarian cancer.

Timeline

Before salpingo-oophorectomy:

  1. Patient undergoes genetic testing to determine if they have high-risk germline mutations such as BRCA1 or BRCA2.
  2. Patient may be recommended for preventive therapies such as tamoxifen or aromatase inhibitors to reduce their risk of developing breast cancer.
  3. Patient may also consider bilateral risk-reducing mastectomy to further reduce their risk of breast cancer.
  4. For premenopausal women with BRCA mutations, bilateral risk-reducing salpingo-oophorectomy may also be recommended to reduce their risk of developing breast and ovarian cancer.

After salpingo-oophorectomy:

  1. Patient undergoes surgery to remove both fallopian tubes and ovaries.
  2. Patient may experience temporary menopausal symptoms such as hot flashes, mood swings, and vaginal dryness.
  3. Patient may need to adjust hormone replacement therapy to manage menopausal symptoms.
  4. Patient is at reduced risk of developing ovarian cancer and may also have a reduced risk of developing breast cancer, especially if they have BRCA mutations.
  5. Patient may need to undergo regular screenings and follow-up appointments to monitor their overall health and well-being.

What to Ask Your Doctor

  1. What is salpingo-oophorectomy and how does it reduce the risk of developing breast cancer?
  2. Am I a candidate for salpingo-oophorectomy based on my personal and family medical history?
  3. What are the potential risks and complications associated with salpingo-oophorectomy?
  4. How will salpingo-oophorectomy affect my hormonal balance and menopausal symptoms?
  5. Will I need hormone replacement therapy after undergoing salpingo-oophorectomy?
  6. Are there any alternative risk-reducing strategies or treatments I should consider in addition to or instead of salpingo-oophorectomy?
  7. How will salpingo-oophorectomy impact my fertility and options for preserving fertility before the procedure?
  8. What is the recovery process like after salpingo-oophorectomy and how long will it take to resume normal activities?
  9. How often will I need follow-up appointments and monitoring after undergoing salpingo-oophorectomy?
  10. Are there any long-term effects or considerations I should be aware of after having salpingo-oophorectomy?

Reference

Authors: Thorat MA, Balasubramanian R. Journal: Best Pract Res Clin Obstet Gynaecol. 2020 May;65:18-31. doi: 10.1016/j.bpobgyn.2019.11.006. Epub 2019 Nov 21. PMID: 31862315