ICARE Newsletter Fall 2022 

  BRCA1/2 Cancer Risk Updates

During preventive surgery to remove the ovaries and fallopian tubes (called a risk-reducing salpingo-oophorectomy or
RRSO), a new study found that the detection of tubal intraepithelial carcinoma predicts the risk of later peritoneal
cancer.1 These findings show the importance of timely RRSO and the need to do a careful pathology exam of the ovaries and fallopian tubes to detect cancer. More research is needed to figure out how to best treat patients with isolated serous tubal intraepithelial carcinoma.

Breast cancer risk following preventive RRSO was studied in three recent reports, which varied in their results as outlined in the table below. Overall, these studies consistently suggest that RRSO may reduce breast cancer risk, particularly in BRCA2 carriers, in the 5 years following surgery. The data is less consistent for BRCA1 carriers, where a
subsequent study (which included ICARE participants), focused on breast cancer risk following preventive removal of the ovaries, reported decreased breast cancer risks in those with prior breast cancer yet no protective effect of RRSO was seen in those without a prior diagnosis of breast cancer. Authors concluded that RRSO does not reduce breast cancer risk in BRCA1 carriers. This study showed how various sources of bias can influence results in studies involving individuals with either a genetic predisposition or strong family history of disease, which in turn may erroneously influence clinical care recommendations. Authors also reiterated that regardless of these results, BRCA1 carriers should be offered RRSO at age 35 to reduce the risk of ovarian and fallopian tube cancer. In those that have preventive removal of their ovaries, a frequent concern is the side effects of premature menopause and use of hormone replacement therapy (HRT). Several studies have suggested this to be safe, including a recent study which showed that HRT is reasonable to offer to BRCA1/2 carriers after preventive removal of the ovaries.

In addition to preventive RRSO, which is currently the most effective strategy to reduce risks for these cancers, other strategies such as oral contraceptives and implants have also been studied. A recently published study suggests oral contraceptives and implants significantly lower risk of ovarian cancer in BRCA1/2 carriers. Similar findings were seen with injectables, but results did not reach statistical significance.

Finally, it is known that adult weight gain is a risk factor for ovarian cancer in the general population; however, a recent
study showed this to also be the case in BRCA1/2 carriers.These findings highlight the importance for BRCA1/2 carriers to maintain a healthy body weight throughout adulthood.

1 Steenbeek et al. J Clin Oncol. 2022;40(17):1879-1891. PMID: 35302882. Social media post May 24 th, 2022. Available at: https://tinyurl.com/post5242022;
2Mavaddat et al. Breast Cancer Res. 2020;22(1):8. PMID: 31948486. Social media post September 27th, 2022. Available at: https://tinyurl.com/post9272022;

3Choi et al. JAMA Oncol. 2021;7(4):585-592. PMID: 33630024. Social media post September 27th, 2022. Available at: https://tinyurl.com/post9272022;
4Wang et al. Eur J Surg Oncol. 2022;48(6):1209-1216. PMID: 35216860. Social media post September 27th, 2022. Available at: https://tinyurl.com/post9272022;
5 Kotsopoulos et al. Cancer Epidemiol Biomarkers Prev. 2022;31(7):1351-1358. PMID: 35477169.
Social media post September 25th, 2022. Available at: https://tinyurl.com/post9252022;
6Mills et al. Gynecol Oncol. 2020;157(3):706-710. PMID: 32143914. Social media post September 26th, 2022. Available at: https://tinyurl.com/post9262022;
7 Xia et al. Gynecol Oncol. 2022;164(3):514-521. PMID: 35063280. Social media post September 21st, 2022. Available at: https://tinyurl.com/post9212022;
8 Kim et al. Cancer Epidemiol Biomarkers Prev.
2021;30(11):2038-2043. PMID: 34426412. Social media post October 1st, 2022. Available at: https://tinyurl.com/post10012022.

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