Reducing risk of BSO & HRT below age of natural menopause SIP 66

Question 1

Which genes cause increased risk ovarian cancer?

Answer 1

BRCA 1 & 2
RAD 51C, 51D
BRIP1
PLAB2
Lynch syndrome genes (MLH1, MSH2, MSH6)

Question 2

If HRT used in early menopause does it increase the risk of breast cancer? Even with those with BRCA 1/2

Answer 2

No

Question 3

Most common cause of death of gynaecological cancer?

Answer 3

Ovarian cancer

Question 4

What is the 10 year survival of ovarian cancer?

Answer 4

30%

Question 5

With BRCA1/BRAC2 following risk-reducing SO (RRSO) - what is the remaining risk of primary peritoneal cancer?

Answer 5

2-4%
Few cases with Lynch

Question 6

For women with Lynch syndrome what additional procedure is performed along side BSO? Why?

Answer 6

Hysterectomy - 40-60% lifetime risk of cancer.

Question 7

If unable to access gene testing, over what lifetime risk of ovarian cancer is RRSO offered?

Answer 7

10% + lifetime risk.

Question 8

RRSO is cost effective if greater lifetime risk of ovarian cancer of what?

Answer 8

4-5% +

Question 9

For which mutations is risk reducing surgery offered 35-40years?

Answer 9

BRCA 1 (RRSO)
Lynch syndrome (Hysterectomy and RRSO)

Question 10

For which mutations is risk reducing surgery offered age 40-45year?

Answer 10

BRCA 2 (RRSO)

Question 11

For which mutations is risk reducing surgery offered age 40-50year?

Answer 11

RAD51C RAD 51D

Question 12

For which mutations is risk reducing surgery offered age >45-50?

Answer 12

BRIP1
PALB2

Question 13

Impact of RRSO on sexual dysfunction

Answer 13

74% reports sexual dysfunction (vs 40-45% in general population)

Question 14

premenopausal oophorectomy reduced free androgen index levels by how much?

Answer 14

50%

Question 15

When should HRT for RRSO be stopped?

Answer 15

Age 51

Question 16

If personal history of breast cancer can HRT be given?

Answer 16

Contraindicated in ER positive status

If triple negative HRT can be considered for short term use on individual basis.

Question 17

Other contraindicated

Answer 17

Personal Hx VTE/thrombophila (can consider transdermal on case by case basis)
Undiagnosed vaginal bleeding

Question 18

Once on HRT when should be reviewed?

Answer 18

At 3 months, then annually

Question 19

In RRSO when to offer DEXA scan?

Answer 19

1-2 years after RRSO.
If osteoporosis or RF - repeat every 2-5years

Question 20

Flow diagram showing HRT decision making

Answer 20

Question 21

Alternatives for HRT is decline or contraindicated?

Answer 21

CBT
SSRI/SSNRI
Vaingal lubricants
Lifestyle - weight baring exercise, weight 18-25, vitamin D/C.

Question 22

If HRT not taken, what is the increases risk of mortality from heart disease?

Answer 22

3%