Cohort study of high-grade serous carcinoma after risk-reducing salpingo-oophorectomy in BRCA1/2 germline pathogenic variant carriers

Risk-reducing salpingo-oophorectomy (RRSO) is carried out to prevent high-grade serous carcinoma (HGSC) in BRCA1/2 germline pathogenic variant (GPV) carriers; however, some women still develop HGSC after RRSO without pathologic findings. A multicenter study in the Hereditary Breast and Ovarian cancer in the Netherlands (HEBON) cohort found that among 2519 GPV carriers with a median follow-up of 13.4 years (range 0.0-27.6) after RRSO, the cumulative incidence rate of HGSC was 1.5% (95% CI 0.0-2.1) for BRCA1 and 0.2% (0.0-1.4) for BRCA2 GPV carriers. Incomplete embedding of the RRSO specimen (HR 4.2; 95% CI 1.4-2.6), higher age at RRSO (HR per year 1.1; 1,0-1,1), and carrying a BRCA1 GPV (HR 12.1; 1.6-91.2) were associated with higher risk of HGSC. The authors conclude that in BRCA1/2 GPV carriers, long-term incidence or HGSC after RRSO without pathologic findings was low, and that strict adherence to guidelines regarding timely RRSO followed by complete specimen embedding can further reduce the risk.