Support of the ‘fallopian tube hypothesis’ in a prospective series of risk-reducing salpingo-oophorectomy specimens

• Published in: European journal of cancer (1990) Vol. 49; no. 1; pp. 132 - 141
• Main Authors: Reitsma, Welmoed, de Bock, Geertruida H, Oosterwijk, Jan C, Bart, Joost, Hollema, Harry, Mourits, Marian J.E
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01-01-2013; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; BRCA; Fallopian Tube Neoplasms - epidemiology; Fallopian Tube Neoplasms - genetics; Fallopian Tube Neoplasms - prevention & control; Female; Genes, BRCA1; Genes, BRCA2; Genetic Predisposition to Disease; Hematology, Oncology and Palliative Medicine; Heterozygote; Humans; Medical sciences; Middle Aged; Mutation; Neoplasms, Unknown Primary - epidemiology; Neoplasms, Unknown Primary - genetics; Occult carcinoma; Ovarian Neoplasms - epidemiology; Ovarian Neoplasms - genetics; Ovarian Neoplasms - prevention & control; Ovariectomy; Pharmacology. Drug treatments; Prevalence; Risk Factors; Risk-reducing salpingo-oophorectomy; Serous tubal intraepithelial carcinoma; Tumors; Risk-reducing salpingo-oophorectomy; BRCA; Occult carcinoma; Serous tubal intraepithelial carcinoma; Malignant tumor; Epithelium; Fallopian tube; Prospective; Cancerology; Female genital system; Risk factor; Serous carcinoma; Salpingo ovariectomy; Cancer
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2012.07.021

Abstract Objective To determine the prevalence, localisation and type of occult (non)invasive cancer in risk-reducing salpingo-oophorectomy (RRSO) specimens in BRCA -mutation carriers and high-risk women from BRCA -negative families. Methods A consecutive series of RRSO specimens of asymptomatic, screen-negative high-risk women were prospectively collected in our tertiary multidisciplinary cancer clinic from January 2000 until March 2012. All high-risk women in this study underwent genetic testing on BRCA -mutations. The surgico-pathological protocol comprised complete resection of ovaries and fallopian tubes, transverse sectioning at 2–3 mm (sectioning and extensively examining the fimbrial end [SEE-FIM] protocol from 2006) and double independent pathology review of morphologically deviant sections. Results Three hundred and sixty RRSOs were performed in 188 BRCA1- carriers, 115 BRCA2 -carriers and 57 BRCA -negative women at a median age of 44.0 years. Four occult invasive cancers were detected in BRCA -carriers (1.3%, 95%-confidence interval (CI) 0.03–2.61), all in BRCA1 -carriers >40 years of age. All cancers, of which two tubal and two ovarian cancers, were FIGO-stage I/II. Three non-invasive serous intraepithelial carcinomas (STICs) were detected in BRCA -carriers (1.0%, 95%-CI 0.00–2.10). In BRCA -negative women one STIC was found (1.8%, 95%-CI 0.00–5.16), however she carried an unclassified variant in BRCA2 . Total follow-up after RRSO was 1691 woman-years, in which one BRCA1 -carrier developed peritoneal cancer (0.3%, 95%-CI 0.00–0.82). Conclusions A low prevalence of occult invasive cancer (1.1%) was found in young asymptomatic, screen-negative women at increased ovarian cancer risk undergoing RRSO. This study adds to the advice to perform RRSO in BRCA1 -carriers before the age of 40. Our findings support the hypothesis of the fallopian tube as the primary site of origin of pelvic high-grade serous cancer.