Prophylactic Surgical Mgment:Breast-Ovarian Ca Syndrome

#C190 Coordinated Prophylactic Surgical Management for Women with Breast-Ovarian Cancer Syndrome.

Karen Lu, Elisabeth Beahm, Banu Arun, Diane Bodurka-Bevers, Charlotte Sun, Michael Miller, Kelly Hunt, Frederick Ames, Louise Strong, Funda Meric-Bernstam,

UT M. D. Anderson Cancer Ctr., Houston, TX.

Background: Women with Breast Ovarian Cancer Syndrome are at dramatically increased risk for developing breast and ovarian cancer in their lifetime.

With the availability of clinical genetic testing for BRCA1 and BRCA2, we are able to better identify those women who are at increased risk.

Preventive options for these high risk women include chemoprevention and prophylactic surgery.

Prophylactic mastectomy decreases risk of breast cancer by greater than 90%. Prophylactic salpingo-oophorectomy decreases risk of ovarian cancer by greater than 95%.

The purpose of this study was to review a series of cases in which breast, gynecologic and reconstructive surgery was performed in high risk women for the purposes of prophylaxis to determine feasibility of a coordinated surgical approach.

Methods: High risk women who had undergone prophylactic breast and prophylactic gynecologic surgery at the same time with or without reconstruction were included.

Clinical, demographic and genetic characteristics were abstracted from medical records. Surgical procedures, operating times and complications were recorded.

Institutional Review Board approval was obtained.

Results: Twelve women who had coordinated prophylactic surgery were identified. Eleven of the 12 women were known to carry a BRCA1 or BRCA2 mutation.

The mean age was 43 years (range 34-65). Ten of the 12 women had a history of breast cancer. Four of the women were undergoing therapeutic/completion mastectomies in addition to the prophylactic procedures.

Nine of the women also had immediate breast reconstruction, all with free TRAM flaps.

Seven of the twelve women underwent a hysterectomy in addition to the bilateral salpingo-oophorectomy.

Mean operating time was 9.3 hours (range 3-16). Mean post-op hospitalization was 5.4 days (range 4-8).

Complications included a re-operation for flap congestion, a superficial epidermalysis of the umbilicus, an intra-operative hypotensive episode of unclear etiology and an aspiration pneumonia.

Conclusion: Women who chose coordinated breast and gynecologic surgical prophylaxis were BRCA1 or BRCA2 mutation carriers, most of whom had a history of breast cancer.

Performing a prophylactic bilateral salpingo-oophorectomy or total abdominal hysterectomy with bilateral salpingo-oophorectomy at the time of mastectomy with or without reconstruction extends operating time but not hospitalization stay.

At institutions where TRAM flaps are utilized for breast reconstruction, concurrent bilateral salpingo-oophorectomy with or without hysterectomy is a reasonable option.

Data regarding patient satisfaction with this coordinated surgical approach is currently being gathered.

Frontiers in Cancer Prevention Research, 2003 AACR

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