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Re: BSO without hysterectomy From: allanho@aol.com Fri Feb 1 11:37:49 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: R. Daniel Braun: "Re: Magnesium Sulfate May Prevent CP" Previous message: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: BSO without hysterectomy" In reply to: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: BSO without hysterectomy" Next in thread: Henry Gregor: "Re: BSO without hysterectomy" Reply: Henry Gregor: "Re: BSO without hysterectomy" Two patients undergoing urgical prophylaxis to address an increase in ovarian cancer risk were iscovered to harbor occult primary fallopian tube carcinoma on final athology review. Mutational analysis confirmed the presence of a eleterious mutation in BRCA-1 in both patients. CONCLUSION: Currently, onsensus opinions regarding ovarian cancer surgical prophylaxis in gene utation carriers do not include hysterectomy as part of the reventative procedure. This report as well as a growing number of ases of fallopian tube cancer reported in known BRCA-1 and BRCA-2 utation carriers has important implications for recommendations egarding surgical prophylaxis in these women. PMID: 11161856 [PubMed - indexed for MEDLINE -- Take care, John Thanks for the abstract, John.  However, the two patients in this study do not seem convincing enough to start doing hysterectomy on everyone.   The lastest ACOG Practice Bulletin (#89, Jan 2008) still does not recommend doing a hysterectomy at the time of risk reducing BSO: Should hysterectomy be performed at the time of risk–reducing salpingo–oophorectomy for hereditary breast and ovarian cancer? When salpingo–oophorectomy is performed primarily for prevention of ovarian cancer or for the hormonal therapy of breast cancer, hysterectomy is not required. Women with BRCA1 or BRCA2 mutations do not have a known increased risk of endometrial cancer (81). Theoretically, hysterectomy allows more complete removal of the fallopian tube, a target of neoplasia in BRCA1 or BRCA2 mutation carriers. However, the interstitial component of the fallopian tube is not a known location of tubal cancer, and its removal may not be essential (82). Furthermore, there are no data to suggest that uterine preservation results in higher cancer risks in BRCA1 or BRCA2 mutation carriers. Careful consideration of the benefits and risks of elective hysterectomy in conjunction with risk–reducing salpingo–oophorectomy should be made with each woman, including individual risk factors for endometrial and cervical cancer, such as tamoxifen use, body mass index, and history of cervical dysplasia. In younger women undergoing risk–reducing salpingo–oophorectomy who want to use hormones after surgery, hysterectomy allows the use of estrogen without progestins, a regimen shown to be safe in high–risk women for short–term therapy (70). Allan Next message: R. Daniel Braun: "Re: Magnesium Sulfate May Prevent CP" Previous message: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: BSO without hysterectomy" In reply to: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: BSO without hysterectomy" Next in thread: Henry Gregor: "Re: BSO without hysterectomy" Reply: Henry Gregor: "Re: BSO without hysterectomy"

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