Hereditary Breast-Ovarian Cancer Team of the University Medical Centre Groningen (UMCG) - a Report

Female carriers of a germline BRCA1 or BRCA2 mutation have a cumulative lifetime ovarian cancer risk of 39-54% or 11-23%, respectively [1, 2]. Preventive health strategies for these women include gynaecological screening aiming at early cancer detection and prophylactic salpingo-ophorectomy aiming at cancer risk reduction. However, it is becoming increasingly clear that (bi) annual gynaecological screening by transvaginal ultrasonography and serum CA125 estimation in women at increased risk of ovarian cancer is ineffective in detecting presymptomatic ovarian cancer [4]. In a recent publication a positive predictive value of 17% and a sensitivity of less than 50% were found for screening for ovarian cancer in a high-risk population [3]. Preventive bilateral salpingo-oophorectomy (BSO) reduces ovarian cancer risk by 96% and breast cancer risk by 50% or less, depending on the age of preventive surgery. Preventive BSO at a premenopausal age is the most effective strategy to prolong life in the case of a BRCA1 mutation [5]. In our clinic, we therefore counsel women with a BRCA1/2 gene mutation to choose preventive surgery after childbearing age. From the age of 35-40 for BRCA1 mutation carriers and from the age of 40-45 for BRCA2 mutation carriers, these women are advised to undergo a laparoscopic BSO. Counselling is provided at our multidisciplinary outpatient clinic by an experienced gynaecologist who discusses the benefits and drawbacks of the decision for or against preventive surgery with the patient and the (contra) indications for hormonal replacement therapy (HRT). Additional psychological counselling is available from the team’s psychologist. In our clinic, uptake of preventive BSO is more than 70% in the total group of counselled mutation carriers and rises to more than 90% in women by the time they reach the age of 50 years.