From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Women's Cancer Center, Stanford Cancer Center, Stanford, California; Winthrop University Hospital, Mineola, New York; Abington Memorial Hospital, Abington, Pennsylvania; Gynecologic Oncology of Indiana, Indianapolis, Indiana; Columbia University Medical Center, New York, New York; Mayo Clinic, Rochester, Minnesota; Duke University Medical Center, Durham, North Carolina; Society of Gynecologic Oncologists, Chicago, Illinois.
Obstet Gynecol. 2010 Sep;116(3):733-743. doi: 10.1097/AOG.0b013e3181ec5fc1.
Women who do not have a documented germline mutation or who do not have a strong family history suspicious for a germline mutation are considered to be at average risk of ovarian cancer. Women who have confirmed deleterious BRCA1 and BRCA2 germline mutations are high risk of ovarian cancer. In addition, women who have a strong family history of either ovarian or breast cancer may carry a deleterious mutation and must be presumed to be at higher-than-average risk, even if they have not been tested, because there could be other mutations that are either untested or yet undiscovered that confirm higher-than-average risk of these diseases. We reviewed studies pertaining to prophylactic bilateral salpingo-oophorectomy in women at average risk of ovarian cancer who are undergoing hysterectomy for benign disease. We also reviewed the role of prophylactic bilateral salpingo-oophorectomy in preventing ovarian cancer based on the level of risk of the patient. For women at average risk of ovarian cancer who are undergoing a hysterectomy for benign conditions, the decision to perform prophylactic bilateral salpingo-oophorectomy should be individualized after appropriate informed consent, including a careful analysis of personal risk factors. Several studies suggest an overall negative health effect when prophylactic bilateral salpingo-oophorectomy is performed before the age of menopause. Ovarian conservation before menopause may be especially important in patients with a personal or strong family history of cardiovascular or neurological disease. Conversely, women at high risk of ovarian cancer should undergo risk-reducing bilateral salpingo-oophorectomy.
没有明确的种系突变或没有强烈的种系突变家族史的女性被认为患卵巢癌的风险处于平均水平。已经确认存在有害 BRCA1 和 BRCA2 种系突变的女性患卵巢癌的风险很高。此外，有强烈卵巢癌或乳腺癌家族史的女性可能携带有害突变，必须假定其风险高于平均水平，即使她们尚未接受检测，因为可能存在其他未经检测或尚未发现的突变，这些突变可确认其患有这些疾病的风险高于平均水平。我们回顾了与因良性疾病而接受子宫切除术的卵巢癌平均风险女性行预防性双侧输卵管卵巢切除术相关的研究。我们还根据患者的风险水平，回顾了预防性双侧输卵管卵巢切除术在预防卵巢癌中的作用。对于因良性疾病而接受子宫切除术的卵巢癌平均风险女性，在获得适当的知情同意后，应根据个人情况进行个体化决策，包括对个人风险因素进行仔细分析。一些研究表明，在绝经前进行预防性双侧输卵管卵巢切除术会对整体健康产生负面影响。绝经前保留卵巢在个人或强烈的心血管或神经疾病家族史的患者中可能尤为重要。相反，卵巢癌高风险的女性应接受降低风险的双侧输卵管卵巢切除术。
