Comparison of risk-reducing surgery in women with BRCA and non-BRCA ovarian cancer susceptibility genes.

person Zachary Phillip Schwartz Cedars Sinai Medical Center, Los Angeles, CA info_outline Zachary Phillip Schwartz, Mae Zakhour, Andrew John Li, Christine S. Walsh, Bj Rimel, Monica Alvarado, Scott E Lentz, Ilana Cass

Authors person Zachary Phillip Schwartz Cedars Sinai Medical Center, Los Angeles, CA info_outline Zachary Phillip Schwartz, Mae Zakhour, Andrew John Li, Christine S. Walsh, Bj Rimel, Monica Alvarado, Scott E Lentz, Ilana Cass Organizations Cedars Sinai Medical Center, Los Angeles, CA, Spectrum Health Hospitals Gynecologic Oncology, Grand Rapids, MI, Cedars Sinai Medcl Ctr, Los Angeles, CA, Cedars-Sinai Medical Center, Los Angeles, CA, Cedar Sinai Medical Center, Los Angeles, CA, Kaiser Permanente, Southern California, Pasadena, CA, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA Abstract Disclosures Research Funding Other Background: Risk reducing gynecologic surgery (RRSO) is standard of care for women with BRCA mutations. The optimal management for women with non-BRCA ovarian cancer susceptibility mutations remains unclear. We sought to characterize the practice patterns for these women at our two institutions. Methods: Women with germline ovarian cancer susceptibility genes who had a RRSO were identified from 1/2000-1/2019 in an IRB approved study. All patients were asymptomatic with no suspicion for malignancy at time of RRSO. Clinico-pathologic characteristics were extracted from the medical records. Continuous variables were analyzed with Kruskal-Wallis and categorical variables analyzed with chi square and t-tests. Results: 152 BRCA1, 95 BRCA2, and 63 Non-BRCA mutation carriers were identified—50 Lynch (22 MLH1, 13 MSH2, 13 MSH6, 2 PMS2) and 13 Other (6 BRIP1, 2 RAD51C, 5 RAD51D). There was no difference between age at testing, age at RRSO, and interval between testing and RRSO between groups. Genetic counseling was higher in Non-BRCA patients. Family history of ovarian cancer was more common in women with BRCA1 and Other germline mutations compared to BRCA2 and Lynch. Family and personal history of breast cancer was high in all groups except Lynch carriers. Prophylactic mastectomy was seen mostly in BRCA mutation carriers. Concomitant hysterectomy was performed in the majority of women (BRCA1 59%, BRCA2 57%, and Other 62%), with the highest frequency in Lynch carriers (86%, p <.01). Occult cancer was only seen in BRCA mutation carriers: BRCA1 (7%), BRCA2 (2%), Lynch (0%), Other (0%). Conclusions: In this cohort, women with Non-BRCA mutations are managed similarly to women with BRCA mutations. We observed no occult cancers in Non-BRCA patients. The optimal role of surgery as a risk reducing strategy in this group requires further study. BRCA1 BRCA2 Lynch Other p = Age at Genetic Testing (Median, Yr) 42 46 47 46 0.39 Age at RRSO (Median, Yr) 46 47 47 47 0.42 Interval from Test to RRSO (Median, Yr) 0.51 0.64 0.35 0.58 0.72 Documented Genetic Counseling (%) 31 32 100 85 <.01 Fam Hx of Ovarian Cancer (%) 55 29 22 69 <.01 Fam Hx of Breast Cancer (%) 82 71 48 62 <.01 Personal Hx of Breast Cancer (%) 41 43 12 31 <.01 Prophylactic Mastectomy (%) 68 58 0 8 <.01