Wisam Assaf

Pathology results of risk‐reducing salpingo‐oophorectomy in BRCA1/2 carriers and long‐term clinical outcomes

AbstractIntroductionBRCA1/2 mutation carriers have a lifetime ovarian cancer risk of 40%–45% for BRCA1 and 15%–20% for BRCA2. The most effective risk‐reduction strategy for women with known BRCA mutations remains bilateral risk‐reducing salpingo‐oophorectomy (RRSO), which reduces the risk by 80%. The primary objective of this study is to assess the long‐term incidence of primary peritoneal carcinoma (PPC) following RRSO and to evaluate the occurrence of premalignant and malignant lesions.MethodsThis retrospective cohort study followed BRCA1/2‐positive patients who underwent RRSO, using data from two medical centers in Haifa Israel between 2002 and 2023. Data collected included demographic characteristics and pathology results post‐surgery. Outcomes included rates of occult cancer (OC), serous tubal intraepithelial carcinoma (STIC), and PPC.ResultsA total of 214 women underwent RRSO. Of these, 126 (58.8%) had a BRCA1 mutation, 76 (35.5%) had a BRCA2 mutation, and 12 (5.6%) carried both BRCA1 and BRCA2 mutations. During a mean follow‐up of 122.4 months (SD ± 84.0), three patients (1.5%) developed PPC. OC was identified in 13 patients (6.1%) during RRSO. Out of the 13 OC patients, eight (61.5%) were classified as stage 1. The overall survival for the OC population was 117.2 ± 55.9 months. STIC was detected in two patients.ConclusionIn this large retrospective analysis of BRCA carriers who underwent RRSO, we confirmed that long‐term follow‐up is crucial for BRCA mutation carriers undergoing RRSO, as malignancies can still arise over time. In our study, the incidence of PPC was 1.5%, highlighting the need for extended surveillance. These findings underscore the importance of meticulous surgical protocols, expert pathology review, and ongoing monitoring to optimize patient outcomes.