Emad Matanes1, Alexander Volodarsky-Perel2, Neta Eisenberg3, Misgav Rottenstreich4, Amber Yasmeen5, Cristina Mitric6, Susie Lau1, Shannon Salvador1, Walter H Gotlieb7, Liron Kogan8. 1. Division of Gynecologic Oncology, Sir Mortimer B. Davis Jewish General Hospital (Drs. Matanes, Mitric, Lau, Salvador, Gotlieb, and Kogan); Segal Cancer Center, Lady Davis Institute of Medical Research (Drs. Matanes, Volodarsky-Perel, Yasmeen, Lau, Salvador, and Gotlieb); Department of Obstetrics and Gynecology (Drs. Matanes, Volodarsky-Perel, Mitric, Lau, Salvador, and Gotlieb), McGill University, Montreal, Quebec, Canada. 2. Segal Cancer Center, Lady Davis Institute of Medical Research (Drs. Matanes, Volodarsky-Perel, Yasmeen, Lau, Salvador, and Gotlieb); Department of Obstetrics and Gynecology (Drs. Matanes, Volodarsky-Perel, Mitric, Lau, Salvador, and Gotlieb), McGill University, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, Chaim Sheba Medical Center, Tel Hashomer, affiliated with the Sackler Faculty of Medicine (Dr. Volodarsky-Perel). 3. Department of Obstetrics and Gynecology, Yitzhak Shamir Medical Center (Dr. Eisenberg), Tel Aviv University, Tel Aviv. 4. Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Hadassah Medical School, Jerusalem (Drs. Rottenstreich and Kogan), Israel. 5. Segal Cancer Center, Lady Davis Institute of Medical Research (Drs. Matanes, Volodarsky-Perel, Yasmeen, Lau, Salvador, and Gotlieb). 6. Division of Gynecologic Oncology, Sir Mortimer B. Davis Jewish General Hospital (Drs. Matanes, Mitric, Lau, Salvador, Gotlieb, and Kogan); Department of Obstetrics and Gynecology (Drs. Matanes, Volodarsky-Perel, Mitric, Lau, Salvador, and Gotlieb), McGill University, Montreal, Quebec, Canada. 7. Division of Gynecologic Oncology, Sir Mortimer B. Davis Jewish General Hospital (Drs. Matanes, Mitric, Lau, Salvador, Gotlieb, and Kogan); Segal Cancer Center, Lady Davis Institute of Medical Research (Drs. Matanes, Volodarsky-Perel, Yasmeen, Lau, Salvador, and Gotlieb); Department of Obstetrics and Gynecology (Drs. Matanes, Volodarsky-Perel, Mitric, Lau, Salvador, and Gotlieb), McGill University, Montreal, Quebec, Canada. Electronic address: walter.gotlieb@mcgill.ca. 8. Division of Gynecologic Oncology, Sir Mortimer B. Davis Jewish General Hospital (Drs. Matanes, Mitric, Lau, Salvador, Gotlieb, and Kogan); Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University Hadassah Medical School, Jerusalem (Drs. Rottenstreich and Kogan), Israel.
Abstract
OBJECTIVE: Risk-reducing salpingo-oophorectomy (RRSO) is standard treatment among women with BRCA mutations. The aim of this meta-analysis is to evaluate the risk of endometrial cancer (EC) in BRCA1 or BRCA2 germline mutation carriers and to examine the justifiability of prophylactic hysterectomy at the time of RRSO. DATA SOURCES: PubMed, Cochrane Central Register of Controlled Trials, BIOSIS, Medline (Ovid), Web of Science, ClinicalTrials.gov, and Google Scholar were searched. Eleven articles were selected and analyzed using the OpenMetaAnalyst 2012 software. METHODS OF STUDY SELECTION: Randomized controlled studies, cohort studies, and case-control studies evaluating the risk of EC and specifically uterine papillary serous carcinoma (UPSC) in germline BRCA1/2 mutation carriers were included. Articles were excluded if they did not meet the inclusion criteria, or if data were not reported and the authors did not respond to inquiries. We assessed the methodological quality of the included studies on the basis of the Newcastle-Ottawa scale. Dichotomous results from each of the studies eligible for the meta-analysis were expressed as the proportion of patients with EC or UPSC per total number of BRCA mutation carriers, with 95% confidence interval (CI). The Mantel-Haenszel statistical method was used. TABULATION, INTEGRATION, AND RESULTS: Eleven studies reported the outcome of interest and were included in the final meta-analysis. In total, 13 871 carriers of BRCA1 and BRCA2 mutations were identified. The pooled prevalence rates of EC and UPSC in BRCA1/2 mutation carriers were 82/13 827 (0.59%) and 19/11 582 (0.16%), respectively. The EC prevalence was 46/7429 (0.62%) in BRCA1 mutation carriers and 17/3546 (0.47%) in BRCA2 mutation carriers, with relative risk of 1.18 (95% CI, 0.7-2.0). For UPSC, the prevalence was 15/7429 (0.2%) and 3/3546 (0.08%) among BRCA1 and BRCA2 mutation carriers, respectively, (relative risk 1.39; 95% CI, 0.5-3.7). CONCLUSION: Most studies in this meta-analysis suggest a slightly increased risk of EC in BRCA mutation carriers, mainly for BRCA1. The decision regarding concurrent hysterectomy should be tailored individually to each patient on the basis of the patient's age, type of mutation, future need for hormone replacement treatment, history of breast cancer, tamoxifen use, and personal operative risks.
OBJECTIVE: Risk-reducing salpingo-oophorectomy (RRSO) is standard treatment among women with BRCA mutations. The aim of this meta-analysis is to evaluate the risk of endometrial cancer (EC) in BRCA1 or BRCA2 germline mutation carriers and to examine the justifiability of prophylactic hysterectomy at the time of RRSO. DATA SOURCES: PubMed, Cochrane Central Register of Controlled Trials, BIOSIS, Medline (Ovid), Web of Science, ClinicalTrials.gov, and Google Scholar were searched. Eleven articles were selected and analyzed using the OpenMetaAnalyst 2012 software. METHODS OF STUDY SELECTION: Randomized controlled studies, cohort studies, and case-control studies evaluating the risk of EC and specifically uterine papillary serous carcinoma (UPSC) in germline BRCA1/2 mutation carriers were included. Articles were excluded if they did not meet the inclusion criteria, or if data were not reported and the authors did not respond to inquiries. We assessed the methodological quality of the included studies on the basis of the Newcastle-Ottawa scale. Dichotomous results from each of the studies eligible for the meta-analysis were expressed as the proportion of patients with EC or UPSC per total number of BRCA mutation carriers, with 95% confidence interval (CI). The Mantel-Haenszel statistical method was used. TABULATION, INTEGRATION, AND RESULTS: Eleven studies reported the outcome of interest and were included in the final meta-analysis. In total, 13 871 carriers of BRCA1 and BRCA2 mutations were identified. The pooled prevalence rates of EC and UPSC in BRCA1/2 mutation carriers were 82/13 827 (0.59%) and 19/11 582 (0.16%), respectively. The EC prevalence was 46/7429 (0.62%) in BRCA1 mutation carriers and 17/3546 (0.47%) in BRCA2 mutation carriers, with relative risk of 1.18 (95% CI, 0.7-2.0). For UPSC, the prevalence was 15/7429 (0.2%) and 3/3546 (0.08%) among BRCA1 and BRCA2 mutation carriers, respectively, (relative risk 1.39; 95% CI, 0.5-3.7). CONCLUSION: Most studies in this meta-analysis suggest a slightly increased risk of EC in BRCA mutation carriers, mainly for BRCA1. The decision regarding concurrent hysterectomy should be tailored individually to each patient on the basis of the patient's age, type of mutation, future need for hormone replacement treatment, history of breast cancer, tamoxifen use, and personal operative risks.
Authors: Luisa Sánchez-Lorenzo; Diego Salas-Benito; Julia Villamayor; Ana Patiño-García; Antonio González-Martín Journal: Cancers (Basel) Date: 2022-02-27 Impact factor: 6.639