Our Summary

This research paper focuses on a preventative surgery known as risk-reducing salpingo-oophorectomy, which is used to prevent ovarian cancer in patients with a hereditary risk of breast-ovarian cancer. The paper discusses how this surgery was first performed in Japan in 2008 and has since been performed on 20 patients through 2019. Until recently, this surgery was not covered by Japanese National Health Insurance, limiting its use. However, since April 2020, the surgery has been covered for patients with breast-ovarian cancer syndrome and pre-existing breast cancer, which is expected to increase its use in Japan.

The research involved a retrospective review of the 20 cases at their hospital to identify any issues with implementing the surgery. They found that the majority of patients had specific variant genes (BRCA1 and BRCA2) that indicated the need for the surgery. The average age of patients was 49, with most having gone through menopause and having a history of breast cancer.

A quarter of the patients experienced vasomotor symptoms (changes in blood flow causing hot flashes or sudden sweats), with most treated with Chinese medicine. Two patients (10%) were found to have hidden (occult) cancer in the removed ovaries, although no one developed cancer in the lining of the abdomen (peritoneal carcinogenesis) after the surgery.

The research concludes that the patients who paid for the surgery themselves were older than the recommended age for the procedure, which might explain the higher rate of hidden cancers found. The researchers recommend that the surgery be performed at the suggested age to ensure it is effective in preventing cancer.

FAQs

  1. What is risk-reducing salpingo-oophorectomy?
  2. What were the common issues experienced by patients who underwent risk-reducing salpingo-oophorectomy, according to the research?
  3. Why do the researchers recommend the surgery be performed at a suggested age?

Doctor’s Tip

A helpful tip that a doctor might give a patient about salpingo-oophorectomy is to carefully consider the timing of the surgery in relation to their age and individual risk factors. It is important to undergo the procedure at the recommended age to maximize its effectiveness in preventing cancer. Additionally, patients should discuss with their healthcare provider any potential symptoms or side effects they may experience after the surgery, such as vasomotor symptoms, so that appropriate management strategies can be put in place. Regular follow-up appointments and screenings should also be scheduled to monitor for any signs of cancer recurrence or complications.

Suitable For

Overall, patients who are typically recommended salpingo-oophorectomy are those with a hereditary risk of breast-ovarian cancer, specifically those with BRCA1 and BRCA2 gene mutations. These patients may have a history of breast cancer, have gone through menopause, and are at an age where the surgery is most effective in preventing ovarian cancer. It is important for patients to be properly evaluated and counseled on the risks and benefits of the surgery before undergoing the procedure.

Timeline

  • Before the surgery: Patients undergo genetic testing to determine if they have specific variant genes (BRCA1 and BRCA2) that indicate a high risk of breast-ovarian cancer. Patients may also have a history of breast cancer and go through menopause. The decision to undergo the surgery is made based on the patient’s individual risk factors and medical history.

  • During the surgery: Salpingo-oophorectomy is performed to remove the ovaries and fallopian tubes, reducing the risk of developing ovarian cancer. The surgery is typically done laparoscopically, with a small incision made in the abdomen for the laparoscope to be inserted. The procedure can take a few hours, and patients are usually under general anesthesia.

  • After the surgery: Patients may experience vasomotor symptoms such as hot flashes or sudden sweats, which can be treated with medication or alternative therapies like Chinese medicine. Some patients may also have hidden (occult) cancer found in the removed ovaries, although the risk of peritoneal carcinogenesis (cancer in the lining of the abdomen) is low. Patients are monitored closely after the surgery to ensure proper healing and to detect any potential complications.

Overall, the surgery is recommended for patients with a high risk of ovarian cancer due to hereditary factors, and can be an effective preventive measure in reducing the risk of developing this type of cancer. It is important for patients to discuss their options with their healthcare provider and to consider the potential benefits and risks of the surgery in their individual case.

What to Ask Your Doctor

Some questions a patient should ask their doctor about salpingo-oophorectomy include:

  1. What is the purpose of this surgery and why is it recommended for me?
  2. What are the potential risks and complications associated with the surgery?
  3. How will the surgery affect my hormone levels and menopausal symptoms?
  4. What is the recovery process like and how long will it take for me to resume normal activities?
  5. Will I need hormone replacement therapy after the surgery?
  6. How often will I need follow-up appointments and screenings after the surgery?
  7. What are the chances of finding hidden cancers during the surgery?
  8. How will the surgery impact my risk of developing ovarian and breast cancer in the future?
  9. Are there any alternative treatments or procedures that I could consider instead of salpingo-oophorectomy?
  10. How will the surgery be covered by my insurance and what out-of-pocket costs should I expect?

Reference

Authors: Kobayashi Y, Hirasawa A, Chiyoda T, Ueki A, Masuda K, Misu K, Kawaida M, Hayashi S, Kataoka F, Banno K, Kosaki K, Aoki D. Journal: Jpn J Clin Oncol. 2021 Feb 8;51(2):213-217. doi: 10.1093/jjco/hyaa173. PMID: 33037428