Article type
Year
Abstract
Objectives: The objective of this review was to examine the following hypotheses:
1. Prophylactic oophorectomy reduces the ovarian cancer related mortality rate in women with a familial history of ovarian cancer.
2. Pathological features of ovaries removed from women with a familial history of ovarian cancer differ to those of ovaries removed from non high risk women.
3. Quality of life for women who had undergone prophylactic oophorectomy differed, either in a positive or a negative way, from that of non-oophorectomized women.
Methods: Electronic searches of the Cochrane Gynaecological Cancer Group Trials Register, MEDLINE, EMBASE, CANCERLIT and several other trials registers were performed. We also searched references from relevant articles and contacted authors where necessary.
As it was expected that randomised controlled trials would not be available, all trials on prophylactic oophorectomy in women with a familial history of ovarian carcinoma were eligible for inclusion. However, a prerequisite for all trials was that they considered outcomes for women with a familial history of ovarian carcinoma as an independent group. Outcome measures were required in the areas of morbidity and mortality, pathohistology and quality of life.
Reviewers independently assessed study quality and extracted data. Studies that did not meet the following minimum criteria were excluded:
1.Prospective or retrospective cohort studies (with or without controls) where the incidence of primary peritoneal carcinoma (or ovarian type carcinoma) is the outcome reported.
2.Retrospective histological review of removed ovarian material using a blinded case control design.
3.Cohort studies where psycho-social outcomes are investigated and a control or comparison group was present.
Nine studies met the inclusion criteria for the review.
Results: Although research to date is poor, the evidence that does exist suggests that the risk of ovarian cancer appears to be substantially reduced by oophorectomy, although the remaining risk at this stage is not properly quantifiable. 1,2
The results currently available do not strongly support the hypothesis that pre-malignant alterations (visible using light microscopy) are present in the clinically normal ovaries of women who either have a strong family history of ovarian cancer or who have tested positive for BRCA 1 or 2. 3,4,5,6,7 However, some significant differences have been found using light microscopy. 5,6,7
Neither of the two studies identified of psychosocial outcomes gives any definitive evidence in favour of, or against, prophylactic oophorectomy from a psychosocial perspective. 8,9
Conclusions: Although research to date is poor, the evidence that does exist suggests that the risk of ovarian cancer appears to be substantially reduced by oophorectomy. However, a significant but small risk of development of either ovarian remnant disease or primary peritoneal carcinoma remains. Practitioners should discuss the lack of evidence with the woman herself and describe the risks as presently available. Decisions should be made on an individual basis until further research has been undertaken.
References
1)Struewing JP. Watson P. Easton DF. Ponder BA. Lynch HT. Tucker MA. Prophylactic oophorectomy in inherited breast/ovarian cancer families. Journal of the National Cancer Institute. Monographs. 1995;17:33-5
2)Piver MS. Jishi MF. Tsukada Y. Nava G. Primary peritoneal carcinoma after prophylactic oophorectomy in women with a family history of ovarian cancer. A report of the Gilda Radner Familial Ovarian Cancer Registry. Cancer. 1993;71(9):2751-5
3)Stratton J, Buckley C, Lowe D, Ponder B. Comparison of prophylactic oophorectomy specimens from carriers and non-carriers of a BRCA1 or BRCA2 gene mutation. Journal of the National Cancer Institute. 1999;91(7):626-28
4)Barakat R, Federici M, Saigo P, Robson M, Offit K, Boyd J. Absence of premalignant histologic, molecular, or cell biologic alterations in prophylactic oophorectomy specimens from BRCA1 heterozygotes. Cancer. 2000;89(2):383-390
5)Casey M, Bewtra C, Hoehne L, Tatpati A, Lynch H, Watson P. Histology of prophylactic removed ovaries from BRCA1 and BRCA2 mutation carriers compared with noncarriers in heredity breast ovarian cancer syndromes kindreds. Gynecologic Oncology. 2000;78:278-87
6)Sherman M, Lee J, Burks R, Struewing J, Kurman R, Hartge P. Histopathologic features of ovaries at increased risk for carcinoma. International Journal of Gynecological Pathology. 1999;18:151-57
7)Werness BA. Afify AM. Bielat KL. Eltabbakh GH. Piver MS. Paterson JM. Altered surface and cyst epithelium of ovaries removed prophylactically from women with a family history of ovarian cancer. Human Pathology. 1999;30(2):151-7
8)Swisher E, Babb S, Whelan A, Mutch D, Rader J. Prophylactic oophorectomy and ovarian cancer surveillance. The Journal of Reproductive Medicine. 2001;46(2):87-94
9)Fry A. Busby-Earle C. Rush R. Cull A. Prophylactic oophorectomy versus screening: psychosocial outcomes in women at increased risk of ovarian cancer. Psycho-Oncology. 2001;10(3):231-41
1. Prophylactic oophorectomy reduces the ovarian cancer related mortality rate in women with a familial history of ovarian cancer.
2. Pathological features of ovaries removed from women with a familial history of ovarian cancer differ to those of ovaries removed from non high risk women.
3. Quality of life for women who had undergone prophylactic oophorectomy differed, either in a positive or a negative way, from that of non-oophorectomized women.
Methods: Electronic searches of the Cochrane Gynaecological Cancer Group Trials Register, MEDLINE, EMBASE, CANCERLIT and several other trials registers were performed. We also searched references from relevant articles and contacted authors where necessary.
As it was expected that randomised controlled trials would not be available, all trials on prophylactic oophorectomy in women with a familial history of ovarian carcinoma were eligible for inclusion. However, a prerequisite for all trials was that they considered outcomes for women with a familial history of ovarian carcinoma as an independent group. Outcome measures were required in the areas of morbidity and mortality, pathohistology and quality of life.
Reviewers independently assessed study quality and extracted data. Studies that did not meet the following minimum criteria were excluded:
1.Prospective or retrospective cohort studies (with or without controls) where the incidence of primary peritoneal carcinoma (or ovarian type carcinoma) is the outcome reported.
2.Retrospective histological review of removed ovarian material using a blinded case control design.
3.Cohort studies where psycho-social outcomes are investigated and a control or comparison group was present.
Nine studies met the inclusion criteria for the review.
Results: Although research to date is poor, the evidence that does exist suggests that the risk of ovarian cancer appears to be substantially reduced by oophorectomy, although the remaining risk at this stage is not properly quantifiable. 1,2
The results currently available do not strongly support the hypothesis that pre-malignant alterations (visible using light microscopy) are present in the clinically normal ovaries of women who either have a strong family history of ovarian cancer or who have tested positive for BRCA 1 or 2. 3,4,5,6,7 However, some significant differences have been found using light microscopy. 5,6,7
Neither of the two studies identified of psychosocial outcomes gives any definitive evidence in favour of, or against, prophylactic oophorectomy from a psychosocial perspective. 8,9
Conclusions: Although research to date is poor, the evidence that does exist suggests that the risk of ovarian cancer appears to be substantially reduced by oophorectomy. However, a significant but small risk of development of either ovarian remnant disease or primary peritoneal carcinoma remains. Practitioners should discuss the lack of evidence with the woman herself and describe the risks as presently available. Decisions should be made on an individual basis until further research has been undertaken.
References
1)Struewing JP. Watson P. Easton DF. Ponder BA. Lynch HT. Tucker MA. Prophylactic oophorectomy in inherited breast/ovarian cancer families. Journal of the National Cancer Institute. Monographs. 1995;17:33-5
2)Piver MS. Jishi MF. Tsukada Y. Nava G. Primary peritoneal carcinoma after prophylactic oophorectomy in women with a family history of ovarian cancer. A report of the Gilda Radner Familial Ovarian Cancer Registry. Cancer. 1993;71(9):2751-5
3)Stratton J, Buckley C, Lowe D, Ponder B. Comparison of prophylactic oophorectomy specimens from carriers and non-carriers of a BRCA1 or BRCA2 gene mutation. Journal of the National Cancer Institute. 1999;91(7):626-28
4)Barakat R, Federici M, Saigo P, Robson M, Offit K, Boyd J. Absence of premalignant histologic, molecular, or cell biologic alterations in prophylactic oophorectomy specimens from BRCA1 heterozygotes. Cancer. 2000;89(2):383-390
5)Casey M, Bewtra C, Hoehne L, Tatpati A, Lynch H, Watson P. Histology of prophylactic removed ovaries from BRCA1 and BRCA2 mutation carriers compared with noncarriers in heredity breast ovarian cancer syndromes kindreds. Gynecologic Oncology. 2000;78:278-87
6)Sherman M, Lee J, Burks R, Struewing J, Kurman R, Hartge P. Histopathologic features of ovaries at increased risk for carcinoma. International Journal of Gynecological Pathology. 1999;18:151-57
7)Werness BA. Afify AM. Bielat KL. Eltabbakh GH. Piver MS. Paterson JM. Altered surface and cyst epithelium of ovaries removed prophylactically from women with a family history of ovarian cancer. Human Pathology. 1999;30(2):151-7
8)Swisher E, Babb S, Whelan A, Mutch D, Rader J. Prophylactic oophorectomy and ovarian cancer surveillance. The Journal of Reproductive Medicine. 2001;46(2):87-94
9)Fry A. Busby-Earle C. Rush R. Cull A. Prophylactic oophorectomy versus screening: psychosocial outcomes in women at increased risk of ovarian cancer. Psycho-Oncology. 2001;10(3):231-41