Risk-reducing salpingo-oophorectomy

 In a cross-sectional study of 199 women who had undergone risk-reducing salpingo-oophorectomy, the majority of participants reported moderate or severe menopausal symptoms.   A history of breast cancer was independently associated with more severe symptoms.  Even more than 10 years after surgical menopause, women reported severe symptoms.

Objective: To evaluate the databases on climacteric symptoms and the positive and negative effects of menopausal hormone therapy. Methods: An integrative review was carried out, using as criteria the search in the National Library of Medicine (PubMed) and Scientific Electronic Library Online (SciELO) databases using the descriptors (i) climacteric (ii) hormone replacement (iii) menopause, with the Boolean operator “AND”. Studies published from 2020 to 2024 were included. Results: Among the benefits of hormone therapy are improved sleep, mood disorders, reduced insulin resistance, reduced risk of dementia, improved quality of life, and prevention of cardiovascular diseases when started within the window of opportunity. It must be noted that there are negative points in carrying out hormone replacement therapy, such as an increased risk of gynecological neoplasms, increased liver complications, in addition to there being numerous contraindications to its use. Final considerations: It is known that the benefits of HRT outweigh the risks as long as it is well indicated, within the therapeutic window for its initiation, and respecting the contraindications to the use of the therapy. The improvement in quality of life, sexual practice and years lived in this phase become less difficult with the correct implementation of hormone replacement therapy, thus providing support so that women can get through this phase in the best possible way.

La enfermedad cardiovascular es la principal causa de muerte en mujeres mayores de 50 años. Previo la menopausia, el riesgo cardiovascular (RCV) es muy inferior a la de los hombres; después de ella, el riesgo aumenta aparentemente relacionado a la deficiencia estrogénica que se asocia a mayor prevalencia múltiples factores de RCV (diabetes mellitus, dislipidemia, síndrome metabólico, cambios desfavorables en el peso y distribución de grasa corporal, sensibilidad insulínica y tono simpático, entre otros). De hecho, el National Cholesterol Education Program (NCEP) reconoció a la postmenopausia como un factor de RCV, asignándole el mismo peso que pertenecer al sexo masculino. La pregunta que subsiste hasta ahora es si la Terapia Hormonal de la Menopausia (THM) es capaz de revertir el aumento de riesgo cardiovascular. Objetivo: determinar si existe diferencia en el riesgo coronario de mujeres con y sin menopausia. Metodología. Estudio observacional, transversal, analítico y prospectivo a 108 mujeres durante el año 2022, de 35 a 74 años con y sin menopausia utilizando un test de Framigham para evaluar la relación al riesgo coronario. Resultados: Se observó que las mujeres posmenopáusicas con obesidad presentan un mayor puntaje de riesgo coronario en comparación con sus contrapartes premenopáusicas. Conclusiones. La diferencia en las puntuaciones entre mujeres posmenopáusicas y premenopáusicas indica que la menopausia puede ser un factor significativo en el aumento del riesgo de enfermedad coronaria.

The present work presents an integrative review with recent research on environmental factors linked to breast and cervical cancer. We sought to highlight these two types of cancer due to their relevance in female mortality in the Brazilian and global context. Given this importance, regarding methodology, 1072 articles were found after searching with descriptors for an integrative review, screening 171 articles and subsequently 80 articles on environmental carcinogenesis with a focus on breast and cervical cancer. This is a quantitative study based on data from articles already existing in research databases, to synthesize knowledge from the a priori studies carried out. Data from the research design on environmental carcinogenesis was combined and there was a systematic analysis using exclusion criteria from databases such as SCIELO, PUBMED, VHL, articles were collected, and due to similarity, articles were combined with the results presented in summary form. The results are based on the oncology literature and several works complement each other. For breast cancer, the following factors stand out: physical activity, higher levels of estrogen, progesterone and androgens, female life cycle, diet and dairy products, consumption of light, moderate and chimarrão coffee, obesity and inflammation of WAT, alcohol and tobacco, maternal breastfeeding habit, pesticides and polluted areas. In parallel, regarding cervical cancer there are: HPV, smoking, multiple partners and oral contraceptives, vaginosis and changes in the microbiota.

Introduction: Obesity has become a growing public health problem, and bariatric surgery is considered the most effective treatment for weight loss and remission of comorbidities in cases of severe obesity. However, there is growing concern about the increased risk of developing alcohol use disorders among patients undergoing these procedures. The relationship between bariatric surgery and alcoholism is complex, involving metabolic and psychological changes that can increase susceptibility to alcoholism. This article reviews the incidence, risk factors and clinical implications of alcohol use after bariatric surgery, highlighting the importance of post-operative monitoring to improve long-term results and quality of life for patients. Method: This study uses a bibliographic review with 23 sources of information, consulted in databases such as Pubmed, Scielo, VHL and NCBI, using keywords such as "obesity", "bariatric surgery", "behavioral disorders", "anxiety" and " alcoholism." After selecting the material, there was a detailed analysis of the texts, review by all authors and consensus on the selection. The selected works, published between 2012 and 2024. Discussion: The relationship between bariatric surgery and the increased risk of post-surgical alcoholism is complex and multifactorial. Psychiatric factors, such as depression and anxiety, along with neurobiological and metabolic changes, may contribute to this phenomenon. Different types of bariatric surgery, such as Roux-en-Y gastric bypass, are associated with anatomical and metabolic changes that may increase susceptibility to alcohol. Early psychological and metabolic monitoring can play a crucial role in preventing and managing post-surgical alcoholism. These findings highlight the importance of a multidisciplinary and preventive approach in the care of patients undergoing bariatric surgery.

Some hereditary ovarian cancer cases can be associated with a mutation of a gene involved in the DNA double-strand break repair system other than BRCA, such as BRIP1. This mutation is an emerging indication for prophylactic risk-reducing salpingo-oophorectomy (RRSO): however, anomalous tubal pathologic lesions have not yet been reported during RRSO performed for this specific indication (BRIP1), as largely reported for BRCA mutation carriers.An asymptomatic 64-year-old woman with a family history of ovarian and breast cancer agreed to undergo RRSO for a pathogenic variant of the BRIP1 gene (heterozygous NM_032043.2: c.124delT, p. Cys42Valfs) with normal BRCA genes. Histological examination showed the presence of high-grade serous carcinoma of the fimbria of the right tube of a maximum diameter of 0.4 cm (final FIGO stage IIB).The pathogenic mechanism that leads to the development of high-grade serous ovarian/fallopian tube cancer in patients with mutations of BRIP1 should be the same as for patients with mutations of BRCA1 and 2. Our case confirms to consider BRIP1 mutation to be sufficient to justify RRSO at 45-50 years old. Keywords BRIP1 • Risk-reducing salpingo-oophorectomy • Hereditary ovarian cancer • Primary carcinoma of the fallopian tube • BRCAness • Double-strand break repair

Some hereditary ovarian cancer cases can be associated with a mutation of a gene involved in the DNA double-strand break repair system other than BRCA, such as BRIP1. This mutation is an emerging indication for prophylactic risk-reducing salpingo-oophorectomy (RRSO): however, anomalous tubal pathologic lesions have not yet been reported during RRSO performed for this specific indication (BRIP1), as largely reported for BRCA mutation carriers.An asymptomatic 64-year-old woman with a family history of ovarian and breast cancer agreed to undergo RRSO for a pathogenic variant of the BRIP1 gene (heterozygous NM_032043.2: c.124delT, p. Cys42Valfs) with normal BRCA genes. Histological examination showed the presence of high-grade serous carcinoma of the fimbria of the right tube of a maximum diameter of 0.4 cm (final FIGO stage IIB).The pathogenic mechanism that leads to the development of high-grade serous ovarian/fallopian tube cancer in patients with mutations of BRIP1 should be the same as for patients with mutations of BRCA1 and 2. Our case confirms to consider BRIP1 mutation to be sufficient to justify RRSO at 45-50 years old. Keywords BRIP1 • Risk-reducing salpingo-oophorectomy • Hereditary ovarian cancer • Primary carcinoma of the fallopian tube • BRCAness • Double-strand break repair

Electroconvulsive therapy is a psychiatric treatment technique used in patients who have mental illnesses such as severe depressive disorder, mania and schizophrenia. This method aims to cause changes in the electrical activity of the brain to reestablish the flow of neurotransmitters. With this in mind, treatment with this technique can be used in combination with antipsychotic medications to obtain more favorable results for patients.

Objective: To evaluate how Artificial Intelligence (AI) techniques can be applied to facilitate the early diagnosis of cancer. Methods: Narrative bibliographic review using the PubMed database, applying the search strategy: (artificial intelligence) AND (diagnosis) AND (cancer). 4,119 articles were found and after applying the inclusion and exclusion criteria, only 17 articles were selected to compose the study. Discussion: The role of Artificial Intelligence (AI) in the early diagnosis of cancer is highlighted, with an emphasis on Machine Learning (ML) and Deep Learning (DL) techniques. ML uses algorithms to analyze patterns in large data sets, improving cancer diagnosis and treatment. DL, a subset of ML, uses multi-layer neural networks to interpret complex data, such as medical images, improving accuracy in identifying neoplasms. Although promising, these technologies face challenges such as the applicability of AI processes and the interpretation of genomic data, aiming to advance precision oncology and improve clinical practice. Such procedures have also been criticized for not explicitly highlighting how the model analyzes the data and makes decisions based on certain inputs, raising ethical questions about their applicability. Final considerations: Therefore, Artificial Intelligence and Deep Learning (DL) and Machine Learning (ML) emerge as crucial tools in the diagnosis and early treatment of cancer, improving patient survival and the efficiency of radiotherapy. Although promising, these technologies face accessibility challenges and the need for greater understanding in their application in oncology.

Introduction: The cervix is located between the bottom of the vagina and the uterine cavity. Cervical cancer, a malignant neoplasm, is one of the most common forms of cancer in Brazil. This chronic condition presents symptoms such as abnormal menstruation, pelvic pain after sexual intercourse and vaginal bleeding, among others. To prevent this neoplasia, methods such as vaccination against HPV (human papilloma virus), the use of condoms during sexual intercourse and cervical cytology tests are essential. Objective: The purpose of this article is to investigate the incidence of cervical malignancy among Brazilian women. Methods: this is an observational ecological study, with data obtained by the Information Technology Service of the Unified Health System, DATASUS, and the National Cancer Institute. Results: Cervical cancer is the second most common in the North (20.48/100 thousand) and Northeast (17.59/100 thousand) regions and the third in the Central-West (16.66/100 thousand). In the South region (14.55/100 thousand) it occupies the fourth position and, in the Southeast region (12.93/100 thousand), the fifth position. Furthermore, hospitalization rates due to this pathology fell in the last quarter of 2022, with in October of this year there were 6,621 hospitalizations and in December of the same year there were 2,198 hospitalizations. It is worth highlighting that the southeast region had 2,597 cases of hospitalizations due to this disease, which is the highest rate in Brazil. Conclusion: Therefore, it can be concluded that the percentage of hospitalizations for cervical cancer has suffered a significant reduction. However, this neoplasm is still present in Brazilian society due to the lack of adherence to routine exams that must be carried out on women, such as preventive exams, in addition to the lack of awareness about the importance of using condoms during sexual intercourse.

Objective: To evaluate the effectiveness of early detection of retinoblastoma and current therapeutic options in the regression of ocular tumor. Methods: A bibliographic review was carried out through searches in the PubMed Central (PMC) database. 141 articles were identified. In the end, 18 articles were selected. Results: The studies analyzed suggest that retinoblastoma has been the target of significant advances in early diagnosis, offering hope for improvements in therapeutic options for young patients. The implementation of diagnostic modalities and the search for new drugs that expand therapeutic options are essential for less invasive management, aiming to provide a better quality of life for these patients. Conclusion: Despite advances, significant improvements are needed in investigation, accessibility and image analysis tools.

Objective: To conduct a comprehensive investigation and synthesize the distinct clinical features of ovarian cancer in young women, identifying challenges in diagnosis and evaluating treatment options. Methods: A narrative bibliographic review was conducted using the PubMed database, resulting in 1,197 initial articles. After rigorous application of the inclusion and exclusion criteria, only 16 articles were selected as official sources for the study. Results: Early diagnosis of ovarian cancer, especially in young women, presents significant challenges, with only 19% of cases detected early. Methods such as transvaginal ultrasound (TV-USG) and serum markers, including CA-125 and HE4, play a crucial role in diagnosis. Genetic mutations, such as BRCA1 and BRCA2, guide genetic counseling. Treatment is highly variable, highlighting the multidisciplinary approach. Conclusion: The review focuses on ovarian cancer in young women, highlighting challenges in early diagnosis arising from histological variety and the absence of initial symptoms.

Uterine adenosarcoma (UA) is an infrequent malignancy which contains the epithelium of benign glands and malignant mesenchymal elements. Low-grade adenosarcoma has a sarcomatous part that is uniformly low grade. Uterine adenosarcoma includes 8% of all uterine sarcomas and less than 0.2% of uterine neoplasms. It is more common in perimenopausal or postmenopausal women. Due to the rarity of uterine adenosarcoma, limited information is available to help guide treatment. A 33-year-old woman, who had one child referred to Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, (Tehran, Iran), with a complaint of abnormal uterine bleeding for one year; the sonography reported a polyp in fundal cavity of uterus. The patient underwent hysteroscopy and curettage. The pathology examination revealed uterine adenosarcoma which led to a total hysterectomy and bilateral salpingo-oophorectomy. Abnormal uterine bleeding is the most common symptom of UA. At a young age there is a possibility of misdiagnosis. Hysteroscopy should also be performed if symptomatic or enlarge polypoid lesions are diagnosed preoperatively.

In Brazil, the challenge of smoking arises from complex pharmacological and behavioral interactions that generate nicotine dependence. The psychoactive substance in tobacco, absorbed through inhalation, quickly reaches the central nervous system. The habit stimulates the brain's reward center, releasing neurotransmitters such as dopamine and endorphins and is linked to various diseases, such as cancer and heart problems. The report of a 45-year-old patient who seeks to maintain smoking cessation improved after treatment with nicotine patches and bupropion, but mentions "hot flashes" associated with the menstrual cycle and weight gain. The medical evaluation results in a comprehensive plan, including treatment for smoking and climacteric symptoms. Strategies to avoid relapse and lifestyle changes, such as reducing coffee and fried foods, are recommended. The patient is fully cared for and her cooperation are positive indicators for the effectiveness of the treatment and better quality of life and well-being.

Asymptomatic bacteriuria is a common condition in the elderly, characterized by the presence of bacteria in the urine without the occurrence of clinical symptoms. Proper management of this condition is extremely important as it can help prevent complications, requiring an individualized and evidence-based approach. A literature review was conducted with the aim of evaluating and understanding findings in the literature regarding the treatment and management of elderly patients with asymptomatic bacteriuria. The study is an integrative review of the literature, in which a data search was carried out in the PubMed and Google Scholar databases, using the following descriptors: management of asymptomatic bacteriuria; elderly, with the Boolean operator “and”. The selection considered the interval between 2013 and 2023. The exclusion criteria were works that were not freely available and that did not present the descriptors in the title or abstract. 3 and 1 articles were chosen, respectively, with the greatest thematic relevance from the respective databases. Treating asymptomatic bacteriuria in the elderly indiscriminately is not recommended, as a reduction in morbidity and mortality has not been demonstrated. Treatment is recommended only in situations of pregnancy, urological interventions and recent kidney transplantation and for patients with co-infection or immunocompromised. Therefore, it was observed that antibiotic therapy management in asymptomatic elderly patients does not have benefits that outweigh its harms, in addition to bringing additional costs to health institutions. However, in some specific situations, as described in the literature, there may be an effective result in the treatment of asymptomatic patients.

Goal: to expose the main concepts of Breast Cancer diagnosed during pregnancy, presenting its risk and protective factors, patient profile and diagnosis. Literature Review: Pregnancy-Associated Breast Cancer (CMAG) is a breast cancer disease that affects patients during the first year after pregnancy. CMAG reaches its peak close to the fourth decade of life. There are factors that can be both risk and protective, such as reproductive behavior. Women who conceived 3 years ago have a 2.66 times higher risk compared to those who gave birth 10 years ago, just as a first pregnancy at age 30 can reduce the risk by 25% for all CMAGs. Breastfeeding, unlike reproductive behavior, is restricted to protect the patient, reducing the risk by up to 4.3% every 12 months, adding 7% to this value per pregnancy. The most prevalent Pregnancy-Associated Breast Cancers are those with negative hormone receptors, therefore Triple Negative and HER-2 positive. Both have an advanced staging pattern, high Ki67 index and Invasive Ductal Carcinoma (IDC) histology. Within the CMAG histological classifications, CDI corresponds to 71-100% of cases. Clinical findings in the breast include thickening of the skin, secretion of purulent fluids or blood, inflammatory and lymphatic changes. Pregnancy-Associated Breast Cancer has tropism for vascular tissues and adjacent lymph nodes, causing 2.5 times more metastases than other tumors. Conclusion: There is a need to expand the field of research on Pregnancy-Associated Breast Cancer, given the magnitude of exponential growth presented by this pathology in recent decades.

Factors influencing uptake and timing of risk reducing salpingo-oophorectomy in women at risk of familial ovarian cancer: a competing risk time to event analysis. Objective To evaluate factors affecting uptake of risk-reducing salpingo-oophorectomy(RRSO) over time in women at high-risk of familial ovarian cancer. Design Prospective observational cohort Setting Tertiary high-risk familial gynaecological cancer clinic Population/Sample New clinic attendees between March-2004 and November-2009, fulfilling high-risk criteria for the UK Familial Ovarian Cancer Screening Study. Methods Risk management options discussed included RRSO and ovarian surveillance. Outcomes data were analysed from a bespoke database. The competing risk method was used to model the cumulative incidence function(CIF) of RRSO over time, and Sub-Hazard ratio(SHR) to assess the strength of association of variables of interest with RRSO. Gray's test was used to evaluate the difference in CIF between two groups and multivariable competing risk regression analysis to model the cumulative probabilities of co-variates on the CIF. Results Of 1133 eligible women 265(21.4%) opted for RRSO and 868(69.9%) for screening. Women undergoing RRSO were older (49years,IQR-12.2) than those preferring 3 screening (43.4years,IQR-11.9)(p<0.0005). The cumulative probability(CIF) for RRSO at 5years was 0.55(CI0.45,0.64) for BRCA1/2 carriers and 0.22(CI0.19,0.26) for women of unknown mutation status(p<0.0001); 0.42(95%CI0.36,0.47) for postmenopausal women(p<0.0001); 0.29(95%CI0.25,0.33) for parity ≥1(p=0.009) and 0.47(95%CI 0.39,0.55) for a personal history of breast cancer(p<0.0001). Variables of significance from the regression analysis were: a BRCA1/2 mutation(SHR 2.31(CI 1.7, 3.14)), postmenopausal status(SHR2.16(CI 1.62,2.87)) and a personal history of breast cancer(SHR1.5(CI 1.09,2.06)). Conclusions Decision making is a complex process and women opt for surgery many years after initial risk assessment. BRCA carriers, postmenopausal women and women who had breast cancer are significantly more likely to opt for preventative surgery.

Introduction: Unintentional injuries can occur in the domestic, urban, leisure or rural environment. Objective: To review the main causes of unintentional accidents in children and their prevention. Result: Paying attention to parents regarding the safety of children in different environments must be part of the consultation routine in Basic Health Units, as it represents an important problem and is associated with preventable infant mortality. Conclusion: In the first year of life, falls, suffocation, burns and foreign body aspiration are important causes of unintentional accidents. At the age of 2 to 5 years, falls are followed by suffocation, burns and drowning and, over 5 years, followed by being run over, burns and intoxication. Prevention takes place through different measures, specific to each case. In the context of adolescents, raise awareness about the dangers of alcohol use, domestic accidents, installation of bars on windows, nets on balconies, gates on stairs, bilateral handrails on stairs, positioning of pot handles facing the inside of the stove. As for parks, they depend on measures such as parental supervision, regulation of equipment and establishment of maximum height. In the rural environment, it is important that, in addition to supervision, physical measures are implemented, such as fencing wells; keep the child away from livestock; do not leave it near tractors or allow them to travel as passengers.

BackgroundThe effect of risk-reducing salpingo-oophorectomy (RRSO) on breast cancer risk forBRCA1andBRCA2mutation carriers is uncertain. Retrospective analyses have suggested a protective effect but may be substantially biased. Prospective studies have had limited power, particularly forBRCA2mutation carriers. Further, previous studies have not considered the effect of RRSO in the context of natural menopause.MethodsA multi-centre prospective cohort of 2272BRCA1and 1605BRCA2mutation carriers was followed for a mean of 5.4 and 4.9 years, respectively; 426 women developed incident breast cancer. RRSO was modelled as a time-dependent covariate in Cox regression, and its effect assessed in premenopausal and postmenopausal women.ResultsThere was no association between RRSO and breast cancer forBRCA1(HR = 1.23; 95% CI 0.94–1.61) orBRCA2(HR = 0.88; 95% CI 0.62–1.24) mutation carriers. ForBRCA2mutation carriers, HRs were 0.68 (95% CI 0.40–1.15) and 1.07 (95% CI 0.69–1.64) for RRSO carried o...

OBJECTIVE: To evaluate the effectiveness of new surgical techniques, hormonal therapies and immunotherapies in reducing the risk of ovarian cancer. METHODOLOGY: This is a bibliographic review developed according to the criteria of the PVO strategy. The searches were carried out in the PubMed and SciELO databases. After associating the descriptors used in the researched databases, 14 studies were selected to compose the collection. DISCUSSION: Ovarian cancer is the fifth leading cause of cancer death in women. Patients considered at risk include those who have first-degree relatives affected by ovarian cancer, obesity, smoking, and mutations in the BRCA1 and BRCA2 genes. Prophylactic oophorectomy is a minimally invasive surgical procedure that involves laparoscopic removal of the adnexa and endometrial biopsy. High-grade serous ovarian cancer has a poor prognosis due to the limited effectiveness of currently available chemotherapies. Hormone replacement with estrogen, when properly performed after risk-reducing salpingo-oophorectomy (RRBSO), helps control postmenopausal symptoms. Chemotherapy can induce amenorrhea in 60% to 80% of premenopausal women who receive adjuvant treatment. CONCLUSION: Ovarian cancer requires an approach that provides more information to the population. Chemoprevention, whether natural or synthetic, is an effective alternative, unlike immunotherapy, which has limited and more specific efficacy.

BackgroundThe effect of risk-reducing salpingo-oophorectomy (RRSO) on breast cancer risk forBRCA1andBRCA2mutation carriers is uncertain. Retrospective analyses have suggested a protective effect but may be substantially biased. Prospective studies have had limited power, particularly forBRCA2mutation carriers. Further, previous studies have not considered the effect of RRSO in the context of natural menopause.MethodsA multi-centre prospective cohort of 2272BRCA1and 1605BRCA2mutation carriers was followed for a mean of 5.4 and 4.9 years, respectively; 426 women developed incident breast cancer. RRSO was modelled as a time-dependent covariate in Cox regression, and its effect assessed in premenopausal and postmenopausal women.ResultsThere was no association between RRSO and breast cancer forBRCA1(HR = 1.23; 95% CI 0.94–1.61) orBRCA2(HR = 0.88; 95% CI 0.62–1.24) mutation carriers. ForBRCA2mutation carriers, HRs were 0.68 (95% CI 0.40–1.15) and 1.07 (95% CI 0.69–1.64) for RRSO carried o...

Uterus mullerian adenosarcoma is a very rare malignancy, commonly seen in perimenopausal and postmenopausal women (1). It is composed of biphasic growth patterns, including neoplastic mesenchymal and benign epithelial components (2). Article Info

The aim of this study was to investigate whether serum Anti Müllerian hormone (AMH) predict symptom burden after risk-reducing salpingo-oophorectomy (RRSO) in order to individualize counselling. Methods Patient-reported menopausal symptoms, sexual functioning and psychological distress (depression and anxiety) were assessed one day before (T0), and six weeks (T1) and seven months (T2) after RRSO. AMH was assessed before RRSO. Multivariable regression analysis was used to investigate the association between AMH and short-term and long-term change in symptom burden following RRSO. Results 91 premenopausal women at high risk of ovarian cancer were included. Pre-surgical AMH was not related significantly to change in symptoms post-RRSO. As secondary outcome we found that regular menses before RRSO was associated specifically with long-term increase in hot flushes (sr 0.40, p=0.001; total R 2 0.171) and depression (sr 0.29 p=0.012; total R 2 0.132). Earlier receipt of chemotherapy was associated with long-term improvement in sexual functioning (sr 0.24, p=0.041; total R 2 0.348). Conclusions In this cohort, AMH was not a significant predictor of change in symptoms following RRSO. Regular menses prior to RRSO and earlier receipt of chemotherapy were significantly, but relatively weakly associated with changes in outcomes six weeks and/or seven months after RRSO.

Factors influencing uptake and timing of risk reducing salpingo-oophorectomy in women at risk of familial ovarian cancer: a competing risk time to event analysis. Objective To evaluate factors affecting uptake of risk-reducing salpingo-oophorectomy(RRSO) over time in women at high-risk of familial ovarian cancer. Design Prospective observational cohort Setting Tertiary high-risk familial gynaecological cancer clinic Population/Sample New clinic attendees between March-2004 and November-2009, fulfilling high-risk criteria for the UK Familial Ovarian Cancer Screening Study. Methods Risk management options discussed included RRSO and ovarian surveillance. Outcomes data were analysed from a bespoke database. The competing risk method was used to model the cumulative incidence function(CIF) of RRSO over time, and Sub-Hazard ratio(SHR) to assess the strength of association of variables of interest with RRSO. Gray's test was used to evaluate the difference in CIF between two groups and multivariable competing risk regression analysis to model the cumulative probabilities of co-variates on the CIF. Results Of 1133 eligible women 265(21.4%) opted for RRSO and 868(69.9%) for screening. Women undergoing RRSO were older (49years,IQR-12.2) than those preferring 3 screening (43.4years,IQR-11.9)(p<0.0005). The cumulative probability(CIF) for RRSO at 5years was 0.55(CI0.45,0.64) for BRCA1/2 carriers and 0.22(CI0.19,0.26) for women of unknown mutation status(p<0.0001); 0.42(95%CI0.36,0.47) for postmenopausal women(p<0.0001); 0.29(95%CI0.25,0.33) for parity ≥1(p=0.009) and 0.47(95%CI 0.39,0.55) for a personal history of breast cancer(p<0.0001). Variables of significance from the regression analysis were: a BRCA1/2 mutation(SHR 2.31(CI 1.7, 3.14)), postmenopausal status(SHR2.16(CI 1.62,2.87)) and a personal history of breast cancer(SHR1.5(CI 1.09,2.06)). Conclusions Decision making is a complex process and women opt for surgery many years after initial risk assessment. BRCA carriers, postmenopausal women and women who had breast cancer are significantly more likely to opt for preventative surgery.

Background: BRCA1 mutation carriers are recommended to undergo prophylactic risk-reducing salpingo-oophorectomy (RRSO) between the ages of 35 and 40 or when child bearing is complete, with a possible delay until age 40-45 for BRCA2 mutation carriers. Study Question: Primary outcome was the rate of unsuspected cancer findings during RRSO in a region of northern Italy (Emilia Romagna) and secondary outcomes were details of RRSO: age at surgical intervention, the venue of the procedures in relation to the surgical/pathological quality and the rate/role of concomitant opportunistic hysterectomies. Study Design: Multicentre data collection by invitation to report current RRSO practices. Results: A total of 222 RRSOs (54.5 % BRCA1, 34.7 % BRCA2, 1.8 % BRCA1 and BRCA2 combined, 5.8 % BRCA-VUS and 3.2 % BRCA not better specified) were reported from 9 different centres, half in non-university hospitals and the remainder in university hospitals. Breast cancer survivors (56.3 %) underwent the RRSO at a younger age (47.8 vs 50.6 years, p = 0.02). The mean and median ages at surgical intervention (49.0 and 48.0, respectively) were similar for BRCA1 and BRCA2 mutation carriers, as was the temporal trend in age distribution, and proportions treated in university and nonuniversity hospitals. A diagnosis of ovarian invasive cancer was reported in 3.5 % of subjects, all BRCA1 or BRCA-combined subjects, at a median and mean age of 57 years (range 42-68). Abnormal tubal findings, such as serous tubal intraepithelial lesions (STIL) (100 %), secretory cell outgrowth (SCOUT) (100 %) and STIC (71.4 %), were mainly reported by pathologists in university hospitals. Of the 222 procedures, 15 (6.7 %) included hysterectomies: in none of these cases was a primitive uterine endometrioid or serous cancer found. Conclusions: The results from this multicentre regional study should guide future preventive health policies for RRSO in BRCA mutation carriers.

Introduction: Risk-reducing-salpingo-oophorectomy (RRSO) inevitably leads BRCA mutation carriers to premature menopause. Areas covered: To evaluate the existing evidence for use of postmenopausal hormone therapy (HT) in BRCAmc, after RRSO or menopause occurring naturally, for both breast cancer (BC) survivors and those without BC. Expert opinion: All BC survivors are excluded from any HT treatment: in other BRCAmc, before 51 years of age the benefits of HT overcome the risks after RRSO and/or premature ovarian insufficiency (POF). After 51 years of age, it is important to treat only women with important vasomotor symptoms, after the failure of alternative therapies. Estrogens-only therapy plays a key role in hysterectomized women (HW). In the case of an intact uterus (UW), associations with the lowest dose of progestins/natural progesterone derivatives have to be preferred, as progestins has been shown to play an important role in BC transformation, especially in BRCA1mc. No studies have been performed in BRCAmc with regard to 'progestin-free' HT, in particular the old tibolone (both in HW and UW) and the new tissue-selective estrogen complex (in UW). However, preliminary data obtained from the general population are reassuring about the use of these 'progestin-free' preparations and BC safety.

The aim of this study was to investigate whether serum Anti Müllerian hormone (AMH) predict symptom burden after risk-reducing salpingo-oophorectomy (RRSO) in order to individualize counselling. Methods Patient-reported menopausal symptoms, sexual functioning and psychological distress (depression and anxiety) were assessed one day before (T0), and six weeks (T1) and seven months (T2) after RRSO. AMH was assessed before RRSO. Multivariable regression analysis was used to investigate the association between AMH and short-term and long-term change in symptom burden following RRSO. Results 91 premenopausal women at high risk of ovarian cancer were included. Pre-surgical AMH was not related significantly to change in symptoms post-RRSO. As secondary outcome we found that regular menses before RRSO was associated specifically with long-term increase in hot flushes (sr 0.40, p=0.001; total R 2 0.171) and depression (sr 0.29 p=0.012; total R 2 0.132). Earlier receipt of chemotherapy was associated with long-term improvement in sexual functioning (sr 0.24, p=0.041; total R 2 0.348). Conclusions In this cohort, AMH was not a significant predictor of change in symptoms following RRSO. Regular menses prior to RRSO and earlier receipt of chemotherapy were significantly, but relatively weakly associated with changes in outcomes six weeks and/or seven months after RRSO.

Uterine adenosarcoma (UA) is an infrequent malignancy which contains the epithelium of benign glands and malignant mesenchymal elements. Low-grade adenosarcoma has a sarcomatous part that is uniformly low grade. Uterine adenosarcoma includes 8% of all uterine sarcomas and less than 0.2% of uterine neoplasms. It is more common in perimenopausal or postmenopausal women. Due to the rarity of uterine adenosarcoma, limited information is available to help guide treatment. A 33-year-old woman, who had one child referred to Imam Hossein Medical Center, Shahid Beheshti University of Medical Sciences, (Tehran, Iran), with a complaint of abnormal uterine bleeding for one year; the sonography reported a polyp in fundal cavity of uterus. The patient underwent hysteroscopy and curettage. The pathology examination revealed uterine adenosarcoma which led to a total hysterectomy and bilateral salpingo-oophorectomy. Abnormal uterine bleeding is the most common symptom of UA. At a young age there is a possibility of misdiagnosis. Hysteroscopy should also be performed if symptomatic or enlarge polypoid lesions are diagnosed preoperatively.