bims-ovdlit 2024-04-14 papers

Issue of 2024‒04‒14
five papers selected by
Lara Paracchini, Humanitas Research

Gynecol Oncol Rep. 2024 Jun;53 101376

Ovarian cancer think tank: An overview of the current status of ovarian cancer screening and recommendations for future directions.

Julia M Dexter, Lindsay W Brubaker, Benjamin G Bitler, Barbara A Goff, Usha Menon, Katherine N Moore, Karthik M Sundaram, Christine S Walsh, Saketh R Guntupalli, Kian Behbakht.

Early diagnosis and screening of ovarian cancer remain significant challenges to improving patient outcomes. There is an urgent need to implement both established and modern strategies to address the "early detection" conundrum, especially as new research continues to uncover the complexities of the disease. The discussion provided is the result of a unique research conference focused on reviewing early detection modalities and providing insight into future approaches.

Keywords: Artificial intelligence; Early detection; Prevention; Screening; Tubo-ovarian malignancy

DOI: https://doi.org/10.1016/j.gore.2024.101376

JNCI Cancer Spectr. 2024 Apr 08. pii: pkae027. [Epub ahead of print]

Salpingectomy for ectopic pregnancy reduces ovarian cancer risk-a nation-wide study.

Ju-Chuan Yen, Tzu-I Wu, Rebecca Stone, Tian-Li Wang, Kala Visvanathan, Li-Ying Chen, Min-Huei Hsu, Ie-Ming Shih.

Recent studies propose fallopian tubes as the tissue origin for many ovarian epithelial cancers. To further support this paradigm, we assessed whether salpingectomy for treating ectopic pregnancy had a protective effect using the Taiwan Longitudinal National-Health-Research Database. We identified 316,882 women with surgical treatment for ectopic pregnancy and 3,168,820 age- and index-date-matched controls from 2000-2016. In a nested cohort, 91.5% of cases underwent unilateral salpingectomy, suggesting that most surgically managed patients have salpingectomy. Over a follow-up period of 17 years, the ovarian carcinoma incidence was 0.0069 (95%CI : 0.0060-0.0079) and 0.0089 (95%CI : 0.0086-0.0092) in the ectopic pregnancy and the control groups, respectively (p < .001). After adjusting the events to per 100-person years, the hazard ratio in the ectopic pregnancy group was 0.70 (95%CI : 0.61-0.80). The risk reduction occurred only in epithelial ovarian cancer (HR : 0.73, CI : 0.63-0.86) and not in non-epithelial subtypes. These findings show a decrease in ovarian carcinoma incidence following salpingectomy for treating ectopic pregnancy.

Keywords: National Health Insurance Research Database; ectopic pregnancy; fallopian tube; opportunistic salpingectomy; ovarian cancer

DOI: https://doi.org/10.1093/jncics/pkae027

Gynecol Oncol Rep. 2024 Jun;53 101368

Salpingectomy for ovarian cancer prevention: Video education for the surgeon.

Emily MacArthur, Kara Long Roche, Joseph Sakran, Sunil H Patel, Peter Najjar, Karen H Lu, Megan Gornet, Anja S Frost, Meghan Walrath, Tom Bauer, Gyyong Oh, Rebecca Stone.

Given the unremitting obstacles to effectively screen for and treat ovarian cancer (OC), prevention is a necessary countermeasure. The recent discovery of the fallopian tube as the origin of the most common and deadly type of OC, high grade serous cancer (HGSC), makes prevention through salpingectomy possible (Madsen et al., 2015). Opportunistic salpingectomy (OS) is the practice of removing the post-reproductive fallopian tubes at the time of other intraperitoneal surgery, or for sterilization in lieu of tubal ligation, to decrease OC risk (Falconer et al., 2015). The safety, effectiveness, and reach of OS as a primary prevention strategy depends on the knowledge mobilization of a standard surgical approach for surgeons (Hanley et al., 2017, Morelli et al., 2013). Resources for accomplishing this knowledge mobilization activity are needed. We therefore aim to create a peer-reviewed, publicly available surgical instructional video that facilitates standardization of the practice of salpingectomy for the purpose of OC prevention. Content creation was generated by a team of surgeon stakeholders, medical illustrators, instructional designers, and health education specialists. Expert gynecologic surgeons were filmed performing salpingectomy in order to build a video library. Accurate illustration and editing of live video footage was executed to support surgeons in visualizing key anatomic landmarks to ensure safe and complete fallopian tube excision. Review of eligibility criteria, fundamentals of preoperative counseling, and strategic and technical points were prioritized. This endeavor is strictly educational, with no commercial benefit. Publicly available, peer-reviewed surgical education tools will help us collaborate to safely and equitably expand OS within and beyond the current scope of surgical practice.

Keywords: Ovarian cancer; Prevention; Salpingectomy; Surgery

DOI: https://doi.org/10.1016/j.gore.2024.101368

Breast Cancer Res Treat. 2024 Apr 12.

Uptake of screening and risk-reducing recommendations among women with hereditary breast and ovarian cancer syndrome due to pathogenic BRCA1/2 variants evaluated at a large urban comprehensive cancer center.

Hadeel Assad, Maria Levitin, Nancie Petrucelli, Mark Manning, Hayley S Thompson, Wei Chen, Hyejeong Jang, Michael S Simon.

PURPOSE: Carriers of pathogenic variants in BRCA1/2 have an elevated lifetime cancer risk warranting high-risk screening and risk-reducing procedures for early detection and prevention. We report on prevention practices among women with pathogenic BRCA variants in order to document follow through with NCCN recommendations and to identify barriers to guideline-recommended care.METHODS: Our cohort included women who had genetic testing through a cancer genetic clinic and completed a 54-item questionnaire to measure socio-demographics, medical history, rates of cancer screening and risk-reducing surgery, disclosure of test results, and cancer worry. Outcomes included rates of completion of risk-reducing salpingo-oophorectomy (RRSO), risk-reducing mastectomy (RRM), and NCCN risk-reducing and age-dependent screening guidelines (version 3.2019). Multivariable logistic regression analyses were used to evaluate potential predictors of these outcomes.
RESULTS: Of 129 evaluable women with pathogenic BRCA1/2 variants, 95 (74%) underwent RRSO and 77 (60%) had RRM, respectively, and 107 (83%) were considered adherent to NCCN guidelines. Women with a history of breast or ovarian cancer were more likely to have RRM (OR = 4.38; 95% CI 1.80-11.51; p = 0.002). Increasing age was associated with an increased likelihood of RRSO (OR = 1.05; 95% CI 1.01-1.09; p = 0.019) and decreased likelihood for RRM (OR = 0.95; 95% CI 0.92-0.99; p = 0.013). Women who had RRM were 3 times more likely to undergo RRSO (OR = 2.81; 95% CI 1.10-7.44; p = 0.025). Women who had genetic testing after June 2013 were less likely to have RRM than those tested before June 2013 (OR = 0.42; 95% CI 0.18-0.95; p = 0.040. None of the other measured factors were associated with rates of RRSO, RRM or follow through with NCCN recommendations. There was near universal (127/129) reported disclosure of genetic test results to family members, resulting in the discovery of a median of 1 relative with a pathogenic variant (range = 0-8).
CONCLUSION: An evaluation of follow up practice in a cohort of women with pathogenic variants in BRCA1/2 revealed high rates of reported completion of screening and surgical risk-reducing recommendations. Educational efforts should continue to reinforce the importance of follow-through with guideline recommended care among this high-risk group.

Keywords: BRCA1 ; BRCA2 ; Mastectomy; Salpingo-oophorectomy; Screening and prevention

DOI: https://doi.org/10.1007/s10549-024-07283-0