The Department of Gynecologic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel.
Department of Obstetrics and Gynecology, Chaim Sheba Medical, Center, Ramat-Gan, Israel, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Eur J Obstet Gynecol Reprod Biol. 2022 Nov;278:166-171. doi: 10.1016/j.ejogrb.2022.09.035. Epub 2022 Sep 29.
Germline mutations in the BRCA gene account for most hereditary ovarian and breast cancer. Management of healthy carriers aims to prevent and allow early detection of breast and ovarian cancer. This study compares six different hereditary ovarian cancer management guidelines, highlighting areas of controversy between different societies. We aim to compare international and national guidelines regarding BRCA carriers' management.
A comparative study. We retrieved, reviewed, and compared the most recent guidelines of BRCA mutation carriers from the specializing societies NCCN (National Comprehensive National network) and ESMO (European society of medical oncology), and national societies of the United States (American College of Obstetricians and Gynecologists), England (the Royal College of Obstetricians and Gynecologists), Canada (the Society of Obstetricians and Gynaecologists of Canada) and Spain (Sociedad Española de Oncología Médica).
There is a broad consensus regarding the limited role of screening for early ovarian cancer detection (4 out of 6) (4/6) and regarding the recommendation for implementation of Risk-reducing salpingo-oophorectomy (RRSO) (6/6), some variations exist for age at RRSO. It is widely accepted that risk reducing salpingectomy should be performed only as part of research (5/6), and that the addition of risk-reducing hysterectomy should be individualized (3/6). Not all guidelines address fertility issues, and controversy exists regarding hormone replacement therapy (HRT) recommendations in unaffected young BRCA-mutation carriers following RRSO.
BRCA carrier's management guidelines consist of well-agreed topics such as the ineffective screening for early detection of ovarian cancer and the recommendation of RRSO. HRT remains controversial. Conforming unified recommendations is needed for providing evidence-based recommendations.
BRCA 基因的种系突变导致大多数遗传性卵巢癌和乳腺癌。健康携带者的管理旨在预防和早期发现乳腺癌和卵巢癌。本研究比较了六种不同的遗传性卵巢癌管理指南，强调了不同社会之间的争议领域。我们旨在比较国际和国家关于 BRCA 携带者管理的指南。
比较研究。我们检索、审查并比较了来自专门学会 NCCN（国家综合癌症网络）和 ESMO（欧洲肿瘤内科学会）以及美国（美国妇产科医师学会）、英国（皇家妇产科医师学院）、加拿大（妇产科医生学会）和西班牙（西班牙肿瘤内科学会）的最新 BRCA 突变携带者指南。
对于早期卵巢癌检测的筛查（4/6）（4/6）和 RRSO（6/6）的建议，有广泛的共识，RRSO 的年龄存在一些差异。广泛接受的是，只有作为研究的一部分，才能进行风险降低的输卵管卵巢切除术（RRSO）（5/6），并且应该个体化进行风险降低的子宫切除术（3/6）。并非所有指南都涉及生育问题，并且对于 RRSO 后无影响的年轻 BRCA 突变携带者的激素替代疗法（HRT）建议存在争议。
BRCA 携带者管理指南包括已达成共识的主题，例如早期检测卵巢癌的无效筛查和 RRSO 的建议。HRT 仍然存在争议。需要制定统一的建议，以提供基于证据的建议。
