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National guidelines have focused attention on risk-reducing salpingo-oophorectomy (RRSO) to reduce the risk of both ovarian and breast cancer in women with a deleterious BRCA mutation.1 The role of hysterectomy in the setting of RRSO is less clear and the benefit of such is often the subject of debate. In this issue of JAMA Oncology, Shu and colleagues1 present provocative findings that add to this debate with their article evaluating the risk of uterine cancer following RRSO in women with a BRCA mutation. In this multicenter, prospective cohort study of 1083 such patients, there was no increased risk of endometrioid adenocarcinomas but an increased risk of serous and/or serous-like endometrial carcinoma. Specifically, there were 5 incident cases of serous and/or serous-like endometrial carcinoma that occurred approximately 7 to 12 years after RRSO with an observed/expected (O/E) ratio of 22.2 in the 4 patients with a BRCA1 mutation and an O/E ratio of 6.4 in the 1 patient with a BRCA2 mutation. Given this new information, what factors should clinicians now take into consideration when weighing whether or not hysterectomy should be performed at the time of RRSO? Outlined below are the factors we believe are most important.
Leath CA, Huh WK, Alvarez RD. Drawing the Line in Risk-Reducing Gynecologic Surgery in Women With a BRCA Mutation. JAMA Oncol. 2016;2(11):1409–1411. doi:10.1001/jamaoncol.2016.1773