COMMENTARY

Low Recurrence After Risk-Reducing Surgery for BRCA Carriers

Maurie Markman, MD

Disclosures

February 24, 2017

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Hello. I am Dr Maurie Markman from Cancer Treatment Centers of America in Philadelphia. I want to briefly discuss a very interesting and important paper that appeared in the journal Gynecologic Oncology, entitled "Occult and Subsequent Cancer Incidence Following the Risk-Reducing Surgery in BRCA Mutation Carriers." [1]

There is very strong evidence that this procedure, with its recognized concerns for morbidity and subsequent quality of life in premenopausal woman, reduces the risk for mortality from ovarian cancer, breast cancer, and all-cause mortality. One question that remains: After the performance of this procedure, what is the risk to an individual patient, based upon what is found at surgery, that the cancer might come back?

In this interesting paper, a group of investigators looked at more than 200 patients who had undergone a risk-reducing surgery. In the population where there were no pathologic findings of cancer and no occult cancers, there was a 1% incidence, with relatively long-term follow-up, of the development of a subsequent peritoneal cancer. That, of course, is very important and good news for women who have genetically defined risk and who undergo the procedure. However, there was also a small subset of patients who were found to have in situ tubular cancers. At the time of this procedure, the number of patients in this category, of the more than 200 who underwent surgery, was nine. However, two of those individuals were subsequently found to have a primary cancer of the perineum. Again, the numbers are very small but the information is somewhat worrisome. Therefore, a woman who is undergoing this recognized very beneficial procedure—again, in the proper setting with the defined genetic risk—and who is found at the time of surgery to have this intertubular cancer occultly needs to be watched carefully for the potential risk for subsequent cancer. Of course, additional follow-up in the population studied in this report and other series is important to try to confirm these findings. Overall, the suggestion is that the risk for primary cancer of the peritoneum after a risk-reducing surgery is very important to know, but it is also important to acknowledge that the risk appears to be quite low.

I encourage anyone, particularly those of you who have an interest in this important topic and the management of gynecologic cancers, as well as women with a known mutational risk with BRCA, to read this very interesting and important paper. Thank you for your attention.

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