Four-year follow-up of outcomes following risk-reducing salpingo-oophorectomy in BRCA mutation carriers.

1013 Background: Our group previously reported on the efficacy of risk-reducing salpingo-oophorectomy (RRSO) for the prevention of breast and BRCA-related gynecologic cancer in a prospective cohort of women with documented mutations in BRCA1 or BRCA2. (Kauff ND, et al. NEJM 2002) Limitations of that report included a relatively short mean follow-up of 24.2 months, and inadequate power to analyze the protection afforded by RRSO against breast or BRCA-related gynecologic cancer alone. We present updated analysis of the efficacy of RRSO in a larger cohort of BRCA mutation carriers with intermediate term follow-up.,All women ≥30 years of age with a deleterious mutation in BRCA1 or BRCA2 identified from 6/1/1995 - 1/1/2002 were offered enrollment in a prospective follow-up study. Women with ovarian tissue at risk were recommended to participate in intensive ovarian surveillance or undergo RRSO. Women self-selected interventions. Follow-up was by annual questionnaire, telephone contact or record review. The effect of RRSO on time to diagnosis of breast or BRCA-associated gynecologic cancer was analyzed using Kaplan-Meier analysis and a Cox proportional-hazards model.,145 (67%) of 218 participants underwent RRSO a median of 5.2 months after receiving genetic test Results: Three occult ovarian or fallopian tube cancers were diagnosed at time of RRSO. During a mean 47.8 months of follow-up, 8 BRCA-associated gynecologic cancers were diagnosed in women electing observation, 2 peritoneal cancers were diagnosed in the RRSO group (p=0.010). Of 184 women with breast tissue at risk, 14 breast cancers were diagnosed in 87 women electing surveillance; 5 breast cancers were diagnosed in 97 women electing RRSO (p=0.015). Hazard Ratio (HR) for developing breast cancer following RRSO was 0.30 (95% CI: 0.11 to 0.84, p=0.022). HR for developing ovarian cancer following RRSO was 0.17 (95% CI: 0.04 to 0.78, p=0.023).,With twice our previously reported follow-up, RRSO remains highly protective against subsequent breast and BRCA-associated gynecologic cancer. Patients considering these procedures need, however, to be aware that both breast and peritoneal cancers may still occur after these surgeries. No significant financial relationships to disclose.