Marchetti Claudia, Iadarola Roberta, Palaia Innocenza, di Donato Violante, Perniola Giorgia, Muzii Ludovico, Panici Perluigi Bendetti
From the Department of Gynecological and Obstetrical Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy.
Menopause. 2014 Jul;21(7):763-8. doi: 10.1097/GME.0000000000000126.
BRCA1/2 mutation carriers have greatly elevated lifetime risks of breast, ovarian, and fallopian tube cancers. Bilateral prophylactic salpingo-oophorectomy is recommended to prevent cancer in these women. As it is often performed before natural menopause, it may be accompanied by menopausal symptoms, impaired quality of life, and increased cardiovascular risk.
In this review, we describe the indications, timing, and implications of salpingo-oophorectomy for BRCA-positive women, with a special focus on the risks and benefits of hormone therapy (HT). Furthermore, retrospective and prospective trials of HT in BRCA mutation carriers undergoing prophylactic salpingo-oophorectomy are debated.
Hormonal deprivation after prophylactic salpingo-oophorectomy may negatively impact health and quality of life; most women experience menopausal symptoms shortly after surgical operation. Literature data suggest that HT generally reduces vasomotor symptoms related to surgical menopause, improving sexual functioning without affecting survival.
Despite the limitations of retrospective and prospective observational studies, short-term HT seems to improve quality of life and does not seem to have an adverse effect on oncologic outcomes in BRCA1 and BRCA2 mutation carriers without a personal history of breast cancer. Therefore, randomized and larger trials are urgently needed.
BRCA1/2基因变异携带者患乳腺癌、卵巢癌和输卵管癌的终生风险大幅升高。建议对这些女性进行双侧预防性输卵管卵巢切除术以预防癌症。由于该手术通常在自然绝经前进行，可能会伴有更年期症状、生活质量受损以及心血管风险增加。
在本综述中，我们描述了输卵管卵巢切除术对BRCA基因阳性女性的适应症、时机和影响，特别关注激素疗法（HT）的风险和益处。此外，还对接受预防性输卵管卵巢切除术的BRCA基因变异携带者进行HT的回顾性和前瞻性试验展开了讨论。
预防性输卵管卵巢切除术后的激素剥夺可能对健康和生活质量产生负面影响；大多数女性在手术后不久就会出现更年期症状。文献数据表明，HT通常可减轻与手术绝经相关的血管舒缩症状，改善性功能且不影响生存率。
尽管回顾性和前瞻性观察性研究存在局限性，但短期HT似乎可改善生活质量，且对无乳腺癌个人病史的BRCA1和BRCA2基因变异携带者的肿瘤学结局似乎没有不利影响。因此，迫切需要进行随机且规模更大的试验。
