FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 346:1609-1615 May 23, 2002 Number 21 Next

Abstract PDF PDA Full Text PowerPoint Slide Set Editorial by Haber, D. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Risk-reducing salpingo-oophorectomy is often considered by carriers of BRCA mutations who have completed childbearing. However, there are limited data supporting the efficacy of this approach. We prospectively compared the effect of risk-reducing salpingo-oophorectomy with that of surveillance for ovarian cancer on the incidence of subsequent breast cancer and BRCA-related gynecologic cancers in women with BRCA mutations.

Methods All women with BRCA1 or BRCA2 mutations identified during a six-year period were offered enrollment in a prospective follow-up study. A total of 170 women 35 years of age or older who had not undergone bilateral oophorectomy chose to undergo either surveillance for ovarian cancer or risk-reducing salpingo-oophorectomy. Follow-up involved an annual questionnaire, telephone contact, and reviews of medical records. The time to cancer in the two groups was compared by Kaplan–Meier analysis and a Cox proportional-hazards model.

Results During a mean follow-up of 24.2 months, breast cancer was diagnosed in 3 of the 98 women who chose risk-reducing salpingo-oophorectomy and peritoneal cancer was diagnosed in 1 woman in this group. Among the 72 women who chose surveillance, breast cancer was diagnosed in 8, ovarian cancer in 4, and peritoneal cancer in 1. The time to breast cancer or BRCA-related gynecologic cancer was longer in the salpingo-oophorectomy group, with a hazard ratio for subsequent breast cancer or BRCA-related gynecologic cancer of 0.25 (95 percent confidence interval, 0.08 to 0.74).

Conclusions Salpingo-oophorectomy in carriers of BRCA mutations can decrease the risk of breast cancer and BRCA-related gynecologic cancer.

Salpingo-oophorectomy for the prevention of ovarian and fallopian-tube cancers in carriers of BRCA1 and BRCA2 mutations is widely recommended,^4,7 but support for this approach comes from retrospective studies in which participants either were not genotyped⁸ or were in some cases included in the analysis after self-selection for genetic testing years after the preventive surgery.⁹ Reports of primary peritoneal cancer after oophorectomy in women at risk for hereditary ovarian cancer have called into question the efficacy of this procedure for the prevention of BRCA-related gynecologic (ovarian, fallopian-tube, and primary peritoneal) cancers.^10,11,12,13 Retrospective series have also suggested that oophorectomy may protect against hereditary breast cancers.¹⁴ We report a prospective evaluation of the role of salpingo-oophorectomy in reducing the risk of breast cancer and BRCA-related gynecologic cancers in carriers of BRCA1 and BRCA2 mutations.

Methods

Study Subjects

All women evaluated for possible pathogenic BRCA1 or BRCA2 mutations in the context of genetic counseling at Memorial Sloan-Kettering Cancer Center in New York between June 1, 1995, and May 30, 2001, were offered enrollment in one of three follow-up studies that had been approved by the institutional review board. The study protocols and the results of a different analysis have been described in a previous report.⁵ The current analysis contains additional follow-up and clinical information on 154 patients included in that report, as well as data on 23 carriers of BRCA mutations who were not included in that study. In the current study, we analyzed the prevention of cancer (the reduction in incidence) with surgery as compared with surveillance, whereas the previous study was limited to an analysis of the stage of the cancers that were detected.

Of 272 women found to carry a pathogenic BRCA1 or BRCA2 mutation, 265 elected to participate in follow-up studies. Of these 265 women, 63 who had undergone bilateral salpingo-oophorectomy before genetic testing were excluded from the analysis. An additional 25 women who were younger than 35 years of age at the time of testing were also excluded because, in our study, carriers of BRCA mutations were advised to initiate screening for ovarian cancer or consider risk-reducing oophorectomy after 35 years of age.

All remaining 177 women from 153 families were advised by physicians and staff of the Clinical Genetic Service of the hospital to begin surveillance for ovarian cancer with annual or twice-yearly gynecologic examinations, twice-yearly transvaginal ultrasonographic examinations, and twice-yearly determinations of the serum CA-125 concentration. For women whose childbearing was complete, consideration of salpingo-oophorectomy was recommended. All women with breast tissue at risk (i.e., who had not had bilateral mastectomies) were advised to undergo annual mammographic examinations, to have clinical breast examinations two to four times per year, and to perform breast self-examinations monthly. The option of risk-reducing mastectomy was also discussed. Patients chose their own screening and preventive interventions.

Follow-up through November 30, 2001, involved an annual questionnaire, telephone contact, and review of medical records. Pathology reports were obtained for all new cancers diagnosed during follow-up. Pathology reports were also obtained for 92 percent of risk-reducing surgical procedures. Four patients who were lost to follow-up before the first follow-up contact were excluded from the analysis. Three patients were found to have unsuspected early-stage gynecologic cancer (two had ovarian cancer, and one had fallopian-tube cancer) at the time of risk-reducing salpingo-oophorectomy and were excluded from the statistical analysis of cancer end points.

Statistical Analysis

The salpingo-oophorectomy group included all women who had a risk-reducing salpingo-oophorectomy with or without concomitant hysterectomy after the receipt of genetic-test results. The surveillance group included all women who did not elect to undergo risk-reducing salpingo-oophorectomy. Women who had a therapeutic oophorectomy because of abnormalities found through surveillance for ovarian cancer were included in the surveillance group, and their follow-up data were censored at the date of oophorectomy. For women in the surveillance group, the duration of follow-up was calculated from the date of receipt of genetic-test results to the date of diagnosis of new breast or BRCA-related gynecologic cancer, the date of last contact, or the date of death. For women in the salpingo-oophorectomy group, the duration of follow-up was calculated from the date of salpingo-oophorectomy to the date of diagnosis of new breast or BRCA-related gynecologic cancer, the date of last contact, or the date of death.

The demographic characteristics of the two groups were compared with the use of the independent-sample t-test for continuous variables and Fisher's exact test for discrete variables. Kaplan–Meier analysis and the log-rank test were used to compare the two groups in terms of the time to a subsequent diagnosis of cancer.

To calculate the hazard ratio for the combined incidence of breast cancer and BRCA-related gynecologic cancer after risk-reducing salpingo-oophorectomy, we used a Cox proportional-hazards model for multiple events.^15,16 This model allowed us to adjust for both differing frequency and differing timing of bilateral mastectomy between the two groups by censoring follow-up data related to breast cancer at the time of bilateral mastectomy. A Cox proportional-hazards model was also used to determine the separate hazard ratios for breast cancer after risk-reducing salpingo-oophorectomy and for BRCA-related gynecologic cancer after such surgery. Analyses were performed with the use of SPSS software (version 10.0, SPSS) and S-Plus software (version 6, Insightful). All reported P values are two-sided.

Results

Of 170 women who met the criteria for entry, 98 elected to undergo risk-reducing salpingo-oophorectomy a median of 3.6 months after receiving the results of genetic testing, and 72 chose surveillance for ovarian cancer. There was no significant difference between the two groups in terms of mean age, percentage with BRCA1 or BRCA2 mutations, mean number of first- and second-degree relatives with breast, ovarian, fallopian-tube, or primary peritoneal cancer, and percentage with a history of breast cancer, systemic chemotherapy, or oral-contraceptive use. More women in the salpingo-oophorectomy group than in the surveillance group (29 of 98 women [30 percent] vs. 10 of 72 women [14 percent]) had undergone bilateral mastectomy before the start of follow-up (P=0.02). There was no significant difference in the number of women who underwent bilateral mastectomy during a mean of 24.2 months of follow-up. Complete demographic information for the two groups is summarized in Table 1.

View this table: [in this window] [in a new window]   Table 1. Demographic Characteristics of the Women.

 
Time to Cancer

Total follow-up was 191 woman-years in the salpingo-oophorectomy group and 152 woman-years in the surveillance group. When follow-up data were censored at the time of diagnosis of ovarian cancer or therapeutic oophorectomy, there were 139 woman-years of follow-up for the 72 women who elected surveillance for ovarian cancer. Ovarian cancer was diagnosed in four women and primary peritoneal cancer in one woman a mean of 17.0 months after the receipt of genetic-test results. All these cancers were diagnosed after suspicious or persistent abnormalities were noted either on transvaginal ultrasonography or in the serum CA-125 concentration. An additional seven women in the surveillance group had suspicious or persistent abnormalities that prompted surgical exploration a mean of 1.8 months after the receipt of genetic-test results. In all seven cases, the findings represented benign conditions. With a mean follow-up of 15.3 months after surgery, no new breast or gynecologic cancers had been diagnosed in these seven women.

During 191 woman-years of follow-up in the 98 women who chose to undergo salpingo-oophorectomy, primary peritoneal cancer was diagnosed in 1 woman 16.3 months after salpingo-oophorectomy. No other woman in this group underwent surgical exploration after salpingo-oophorectomy.

During 120 woman-years of follow-up in the 62 women with breast tissue in the surveillance group, breast cancer was diagnosed in 8 women a mean of 12.7 months after the receipt of genetic-test results. During 127 woman-years of follow-up in the 69 women with breast tissue in the salpingo-oophorectomy group, breast cancer was diagnosed in 3 women a mean of 10.3 months after risk-reducing salpingo-oophorectomy.

When the two types of cancer were analyzed together, breast cancer or BRCA-related gynecologic cancer was found to have been diagnosed in a total of four women in the salpingo-oophorectomy group during 186 woman-years of follow-up. In the surveillance group, 13 such cancers were diagnosed in 12 women during 135 woman-years of follow-up (Figure 1). The estimated proportion free from breast cancer or BRCA-related gynecologic cancer at five years (according to the Kaplan–Meier analysis) was significantly greater in the salpingo-oophorectomy group (P=0.006) (Table 2). To take into account the different proportions of women in the two groups who had undergone bilateral mastectomy before study entry, a Cox proportional-hazards model for multiple events was used. This analysis revealed that the hazard ratio for the development of breast cancer or BRCA-related gynecologic cancer after risk-reducing salpingo-oophorectomy was 0.25 (95 percent confidence interval, 0.08 to 0.74) (Table 3). There was no significant effect of the type of mutation (BRCA1 vs. BRCA2) on the time to breast or gynecologic cancer (P=0.31).

View larger version (14K): [in this window] [in a new window]   Figure 1. Kaplan–Meier Estimates of the Time to Breast Cancer or BRCA-Related Gynecologic Cancer among Women Electing Risk-Reducing Salpingo-oophorectomy and Women Electing Surveillance for Ovarian Cancer. P=0.006 by the log-rank test for the comparison between the actuarial mean times to cancer. A Cox proportional-hazards model for multiple end points, which took into account the different proportions of women in the two groups who had breast tissue at risk, yielded a hazard ratio for subsequent breast cancer or BRCA-related gynecologic cancer after risk-reducing salpingo-oophorectomy of 0.25 (95 percent confidence interval, 0.08 to 0.74).

 

View this table: [in this window] [in a new window]   Table 2. Kaplan–Meier Estimates of Proportions Free from Cancer.

 

View this table: [in this window] [in a new window]   Table 3. Hazard of Breast Cancer or BRCA-Related Gynecologic Cancer after Risk-Reducing Salpingo-oophorectomy.

 
When the analysis was limited to new ovarian, fallopian-tube, and primary peritoneal cancers, the time to a diagnosis of cancer was longer in the salpingo-oophorectomy group than in the surveillance group (P=0.04) (Table 2). The hazard ratios for the development of BRCA-related gynecologic cancer or breast cancer after salpingo-oophorectomy are shown in Table 3.

Among the women in the surveillance group for whom detailed data were available, 51 of 63 (81 percent) indicated that they were undergoing ultrasonographic surveillance, CA-125–based surveillance, or both. Among patients undergoing such surveillance for ovarian cancer, a mean of 1.73 transvaginal ultrasonographic examinations (range, 1 to 4) and 1.68 determinations of the serum CA-125 concentration (range, 1 to 4) per year were reported. A total of 51 of 58 women with breast tissue in this group (88 percent) also underwent regular mammographic examination. In the salpingo-oophorectomy group, 63 of 65 women with breast tissue for whom data were available (97 percent) underwent regular mammographic examination. The risk of breast cancer or BRCA-related gynecologic cancer was significantly lower among the 98 women in the salpingo-oophorectomy group than among the 51 women who indicated that they were undergoing ultrasonographic surveillance, CA-125–based surveillance, or both (hazard ratio, 0.19; 95 percent confidence interval, 0.06 to 0.56).

Complications of Risk-Reducing Salpingo-oophorectomy

Complications were noted in 4 of the 80 women who underwent risk-reducing salpingo-oophorectomy without hysterectomy. In one woman, a laparoscopic salpingo-oophorectomy was converted to a laparotomy because there were multiple adhesions at the site of a previous repair of an umbilical hernia. Her postoperative course was complicated by an infection of the wound. In a second woman who underwent laparoscopic salpingo-oophorectomy, perforation of the bladder during the placement of a trocar necessitated drainage by a Foley catheter for five days. A third woman presented with a distal obstruction of the small bowel eight weeks after risk-reducing salpingo-oophorectomy. Operative findings were notable for adhesions between the distal ileum and staples on the right ovarian vessels, which caused a small-bowel obstruction at that point. The obstruction was relieved by lysis of the adhesions without need for bowel resection. In a fourth woman who underwent laparoscopic salpingo-oophorectomy, perforation of the uterus by a uterine manipulator necessitated laparoscopic suturing of the uterus and overnight observation. No complications were noted in 11 women who had a hysterectomy at the time of risk-reducing salpingo-oophorectomy or in 7 women whose uterine-surgery status at the time of risk-reducing salpingo-oophorectomy was not specified.

Discussion

In this study, we prospectively evaluated 170 women with germ-line BRCA mutations who elected either risk-reducing salpingo-oophorectomy or surveillance for ovarian cancer. Survival free of breast cancer and BRCA-related gynecologic cancer was longer in the cohort that chose salpingo-oophorectomy: the projected proportion of women who will be free of breast cancer or BRCA-related gynecologic cancer five years from the time of salpingo-oophorectomy or the beginning of surveillance is 94 percent in the salpingo-oophorectomy group and 69 percent in the surveillance group. Three patients who were not included in the actuarial analysis were found to harbor an occult stage I gynecologic neoplasm at the time of what had been considered to be risk-reducing surgery. Taken together, these results provide strong support for including discussion of risk-reducing salpingo-oophorectomy as part of a preventive-oncology strategy for women with a BRCA1 or BRCA2 mutation. Our findings recall those of Meijers-Heijboer et al.,⁶ who showed in a similar prospective study that risk-reducing mastectomy decreased the risk of breast cancer in carriers of BRCA mutations.

The protective effect of salpingo-oophorectomy in this series was slightly lower than that found in a recent retrospective analysis.⁹ The greater effect in that study may have reflected underascertainment of peritoneal cancers in carriers of BRCA mutations who had previously undergone oophorectomy. The trend toward a decreased risk of breast cancer after oophorectomy in our series is consistent with a previous retrospective case–control series¹⁴ and with the finding that hormone deprivation has a beneficial effect on the risk of breast cancer.^17,18,19,20 The moderate reduction we found in the incidence of breast cancer must, however, be compared with the results recently documented by Meijers-Heijboer et al., in whose study no case of breast cancer occurred after prophylactic mastectomy in 76 women with BRCA mutations followed for the same length of time as in our series.⁶

The incidence of breast cancer and BRCA-related gynecologic cancer in our study of 53 cases per 1000 woman-years is somewhat higher than the 21 to 42 cases per 1000 woman-years that would be predicted on the basis of linkage studies.^21,22,23 This higher incidence may reflect the presence of preexisting cancers that were detected during the first year of follow-up. When the eight patients in whom cancer was diagnosed during the first year of follow-up are excluded from the analysis, the incidence of cancer in our cohort is 25 per 1000 woman-years, which falls within the range derived from linkage studies.

Only 4 of 98 risk-reducing salpingo-oophorectomy procedures (4 percent) in this series were associated with surgical complications. This rate is similar to those reported in other studies of laparoscopic gynecologic procedures^24,25 and lower than the complication rate of 8 to 17 percent associated with abdominal hysterectomy and concomitant bilateral salpingo-oophorectomy.^26,27 This rate contrasts with the complication rate of up to 30 percent that has been reported for risk-reducing mastectomy with reconstruction.²⁸

Approximately 12 percent of the risk-reducing salpingo-oophorectomy procedures in our series included removal of the uterus. Although there is no proven increase in the risk of uterine cancer in carriers of BRCA mutations,²⁹ several authors have recommended concomitant hysterectomy because of the risk of cancer arising from the small amount of intramural fallopian-tube tissue that is left by salpingo-oophorectomy.^30,31 In a previous series, five cases of peritoneal carcinomatosis occurred after hysterectomy with bilateral oophorectomy in women with a hereditary predisposition to cancer.¹¹ Whether hysterectomy further reduces the risk of cancer is unknown, and prospective studies will be required in order to resolve this question.

Although the median time between genetic testing and risk-reducing salpingo-oophorectomy was only 3.6 months, a possible bias may have been introduced by beginning follow-up in the salpingo-oophorectomy group at the time of surgery. According to an analysis in which follow-up for all patients began at the time of notification of genetic-test results, however, salpingo-oophorectomy remained highly protective against breast cancer and BRCA-related gynecologic cancer (hazard ratio, 0.21; 95 percent confidence interval, 0.07 to 0.62). If the three cases of unsuspected gynecologic cancer detected at the time of risk-reducing surgery were included in this analysis, the hazard ratio for development of breast or BRCA-related gynecologic cancer would be 0.37 (95 percent confidence interval, 0.12 to 0.90). Another limitation of our study was the selection of time to cancer rather than overall survival as an end point. Salpingo-oophorectomy may have adverse effects on the lipid profile³² and may increase the risks of cardiovascular disease³³ and osteoporosis.³⁴ There may also be psychosocial and sexual effects. A recent study demonstrated that women who underwent this type of surgery had more physical and emotional symptoms than those who underwent screening.³⁵

Whether our results will translate into improved survival will depend, in large part, on the effectiveness of screening for ovarian cancer. We have found early-stage gynecologic cancers with ovarian ultrasonography and CA-125–based screening,⁵ but these screening methods can fail to detect ovarian cancers at a curable stage.^36,37,38,39 Hormonal chemoprevention of breast cancer and ovarian cancer offers an additional potential strategy for some carriers of BRCA mutations.^40,41 In the absence of novel imaging techniques or new serum markers that can predictably identify early-stage ovarian and fallopian-tube neoplasms, risk-reducing salpingo-oophorectomy remains an important option for women at risk for hereditary breast or gynecologic cancer.

Supported by grants (PRTA-38 [to Dr. Robson] and RP95-10503 [to Dr. Offit]) from the American Cancer Society, a grant (DAMD 17-96-1-6293 [to Dr. Offit]) from the Department of Defense Breast Cancer Research Program, the Society of Memorial Sloan-Kettering Cancer Center, the Koodish Fellowship Fund, the Lymphoma Foundation, the Danziger Foundation, the Frankel Foundation, and the Breast Cancer Research Foundation.

We are indebted to Robin Baum, M.S., Flavia Facio, M.S., Emily Glogowski, M.S., Judy Hull, M.S., Heather Pierce, Ph.D., and Beth Siegel, M.S., for their contributions, care, and follow-up; to the physicians and nurses at Memorial Hospital for their care of the patients; to Bridget Kelly, M.P.H., Amy Finch, Alice Schluger, M.S., Helen Huang, Archana Minnal, Beth Rapaport, and Peter Herndon for technical advice and assistance; and to Susan G. Hilsenbeck, Ph.D., for her critical reading of the manuscript.

Source Information

From the Clinical Genetics Service (N.D.K., M.E.R., L.S., N.A.E., J.B., K.O.), the Breast Cancer Medicine Service (M.E.R., C.A.H., L.N.), and the Developmental Chemotherapy Service (M.H.), Department of Medicine; the Department of Epidemiology and Biostatistics (J.M.S.); and the Gynecology Service (J.B., R.R.B.) and the Breast Service (P.I.B.), Department of Surgery — all at Memorial Sloan-Kettering Cancer Center, New York.

Other authors were Mercedes Castiel, M.D. (Gynecology Service, Department of Surgery), and Khedoudja Nafa, Ph.D. (Clinical Genetics Service, Department of Medicine), Memorial Sloan-Kettering Cancer Center, New York.

Address reprint requests to Dr. Offit at the Clinical Genetics Service, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, or at offitk{at}mskcc.org.

References

1. Struewing JP, Hartge P, Wacholder S, et al. The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews. N Engl J Med 1997;336:1401-1408. [Free Full Text]
2. Ford D, Easton DF, Stratton M, et al. Genetic heterogeneity and penetrance analysis of the BRCA1 and BRCA2 genes in breast cancer families. Am J Hum Genet 1998;62:676-689. [CrossRef][ISI][Medline]
3. Satagopan JM, Offit K, Foulkes W, et al. The lifetime risks of breast cancer in Ashkenazi Jewish carriers of BRCA1 and BRCA2 mutations. Cancer Epidemiol Biomarkers Prev 2001;10:467-473. [Free Full Text]
4. Burke W, Daly M, Garber J, et al. Recommendations for follow-up care of individuals with an inherited predisposition to cancer. II. BRCA1 and BRCA2. JAMA 1997;277:997-1003. [Abstract]
5. Scheuer L, Kauff N, Robson M, et al. Outcome of preventive surgery and screening for breast and ovarian cancer in BRCA mutation carriers. J Clin Oncol 2002;20:1260-1268. [Free Full Text]
6. Meijers-Heijboer H, van Geel B, van Putten WLJ, et al. Breast cancer after prophylactic bilateral mastectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med 2001;345:159-164. [Free Full Text]
7. Eisen A, Rebbeck TR, Wood WC, Weber BL. Prophylactic surgery in women with a hereditary predisposition to breast and ovarian cancer. J Clin Oncol 2000;18:1980-1995. [Free Full Text]
8. Struewing JP, Watson P, Easton DF, Ponder BAJ, Lynch HT, Tucker MA. Prophylactic oophorectomy in inherited breast/ovarian cancer families. In: Hereditary breast, ovarian, and colon cancer. Journal of the National Cancer Institute monographs. No. 17. Washington, D.C.: Government Printing Office, 1995:33-5. (NIH publication no. 94-03837.)
9. Weber BL, Punzalan C, Eisen A, et al. Ovarian cancer risk reduction after bilateral prophylactic oophorectomy (BPO) in BRCA1 and BRCA2 mutation carriers. Am J Hum Genet 2000;67:Suppl 2:59-59.abstract [CrossRef][ISI][Medline]
10. Tobacman JK, Greene MH, Tucker MA, Costa J, Kase R, Fraumeni JF Jr. Intra-abdominal carcinomatosis after prophylactic oophorectomy in ovarian-cancer-prone families. Lancet 1982;2:795-797. [ISI][Medline]
11. Piver MS, Jishi MF, Tsukada Y, Nava G. Primary peritoneal carcinoma after prophylactic oophorectomy in women with a family history of ovarian cancer: a report of the Gilda Radner Familial Ovarian Cancer Registry. Cancer 1993;71:2751-2755. [CrossRef][ISI][Medline]
12. Bandera CA, Muto MG, Schorge JO, Berkowitz RS, Rubin SC, Mok SC. BRCA1 gene mutations in women with papillary serous carcinoma of the peritoneum. Obstet Gynecol 1998;92:596-600. [Abstract]
13. Schorge JO, Muto MG, Welch WR, et al. Molecular evidence for multifocal papillary serous carcinoma of the peritoneum in patients with germline BRCA1 mutations. J Natl Cancer Inst 1998;90:841-845. [Free Full Text]
14. Rebbeck TR, Levin AM, Eisen A, et al. Breast cancer risk after bilateral prophylactic oophorectomy in BRCA1 mutation carriers. J Natl Cancer Inst 1999;91:1475-1479. [Free Full Text]
15. Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999;94:496-509.
16. Therneau TM, Grambsch PM. Modeling survival data: extending the Cox model. New York: Springer, 2000.
17. Brinton LA, Schairer C, Hoover RN, Fraumeni JF Jr. Menstrual factors and risk of breast cancer. Cancer Invest 1988;6:245-254. [ISI][Medline]
18. Schairer C, Persson I, Falkeborn M, Naessen T, Troisi R, Brinton LA. Breast cancer risk associated with gynecologic surgery and indications for such surgery. Int J Cancer 1997;70:150-154. [CrossRef][ISI][Medline]
19. Parazzini F, Braga C, La Vecchia C, Negri E, Acerboni S, Franceschi S. Hysterectomy, oophorectomy in premenopause, and risk of breast cancer. Obstet Gynecol 1997;90:453-456. [Abstract]
20. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 1998;90:1371-1388. [Free Full Text]
21. Easton DF, Ford D, Bishop DT. Breast and ovarian cancer incidence in BRCA1-mutation carriers. Am J Hum Genet 1995;56:265-271. [ISI][Medline]
22. The Breast Cancer Linkage Consortium. Cancer risks in BRCA2 mutation carriers. J Natl Cancer Inst 1999;91:1310-1316. [Free Full Text]
23. Robson M, Gilewski T, Haas B, et al. BRCA-associated breast cancer in young women. J Clin Oncol 1998;16:1642-1649. [Abstract]
24. Bateman BG, Kolp LA, Hoeger K. Complications of laparoscopy -- operative and diagnostic. Fertil Steril 1996;66:30-35. [ISI][Medline]
25. Mirhashemi R, Harlow BL, Ginsburg ES, Signorello LB, Berkowitz R, Feldman S. Predicting risk of complications with gynecologic laparoscopic surgery. Obstet Gynecol 1998;92:327-331. [Abstract]
26. Kovac SR. Hysterectomy outcomes in patients with similar indications. Obstet Gynecol 2000;95:787-793. [Free Full Text]
27. Makinen J, Johansson J, Tomas C, et al. Morbidity of 10 110 hysterectomies by type of approach. Hum Reprod 2001;16:1473-1478. [Free Full Text]
28. Gabriel SE, Woods JE, O'Fallon WM, Beard CM, Kurland LT, Melton LJ III. Complications leading to surgery after breast implantation. N Engl J Med 1997;336:677-682. [Free Full Text]
29. Levine DA, Lin O, Barakat RR, et al. Risk of endometrial carcinoma associated with BRCA mutation. Gynecol Oncol 2001;80:395-398. [CrossRef][ISI][Medline]
30. Paley PJ, Swisher EM, Garcia RL, et al. Occult cancer of the fallopian tube in BRCA-1 germline mutation carriers at prophylactic oophorectomy: a case for recommending hysterectomy at surgical prophylaxis. Gynecol Oncol 2001;80:176-180. [CrossRef][ISI][Medline]
31. Aziz S, Kuperstein G, Rosen B, et al. A genetic epidemiological study of carcinoma of the fallopian tube. Gynecol Oncol 2001;80:341-345. [CrossRef][ISI][Medline]
32. Kritz-Silverstein D, Barrett-Connor E, Wingard DL. Hysterectomy, oophorectomy, and heart disease risk factors in older women. Am J Public Health 1997;87:676-680. [Free Full Text]
33. Colditz GA, Willett WC, Stampfer MJ, Rosner B, Speizer FE, Hennekens CH. Menopause and the risk of coronary heart disease in women. N Engl J Med 1987;316:1105-1110. [Abstract]
34. Aitken JM, Hart DM, Anderson JB, Lindsay R, Smith DA, Speirs CF. Osteoporosis after oophorectomy for non-malignant disease in premenopausal women. Br Med J 1973;2:325-328. [ISI][Medline]
35. Fry A, Busby-Earle C, Rush R, Cull A. Prophylactic oophorectomy versus screening: psychosocial outcomes in women at increased risk of ovarian cancer. Psychooncology 2001;10:231-241. [CrossRef][Medline]
36. Bourne TH, Whitehead MI, Campbell S, Royston P, Bhan V, Collins WP. Ultrasound screening for familial ovarian cancer. Gynecol Oncol 1991;43:92-97. [CrossRef][Medline]
37. Jacobs IJ, Skates SJ, MacDonald N, et al. Screening for ovarian cancer: a pilot randomised controlled trial. Lancet 1999;353:1207-1210. [CrossRef][ISI][Medline]
38. van Nagell JR Jr, DePriest PD, Reedy MB, et al. The efficacy of transvaginal sonographic screening in asymptomatic women at risk for ovarian cancer. Gynecol Oncol 2000;77:350-356. [CrossRef][Medline]
39. Liede A, Karlan BY, Baldwin RL, Platt LD, Kuperstein G, Narod SA. Cancer incidence in a population of Jewish women at risk of ovarian cancer. J Clin Oncol 2002;20:1570-1577. [Free Full Text]
40. Narod SA, Risch H, Moslehi R, et al. Oral contraceptives and the risk of hereditary ovarian cancer. N Engl J Med 1998;339:424-428. [Free Full Text]
41. King MC, Wieand S, Hale K, et al. Tamoxifen and breast cancer incidence among women with inherited mutations in BRCA1 and BRCA2: National Surgical Adjuvant Breast and Bowel Project (NSABP-P1) Breast Cancer Prevention Trial. JAMA 2001;286:2251-2256. [Free Full Text]

Abstract PDF PDA Full Text PowerPoint Slide Set Editorial by Haber, D. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

Related Letters:

Oophorectomy in Carriers of BRCA Mutations
Zhuang S. H., Leonard G. D., Swain S. M., Peshkin B. N., DeMarco T. A., Schwartz M. D., Anderson W. F., Brawley O. W., Chang S., Whitfield G. A., Kauff N. D., Robson M. E., Offit K., Rebbeck T. R., Weber B. L.
Extract | Full Text | PDF  
N Engl J Med 2002; 347:1037-1040, Sep 26, 2002. Correspondence

This article has been cited by other articles:

• Allain, D. C. (2008). Genetic Counseling and Testing for Common Hereditary Breast Cancer Syndromes: A Paper from the 2007 William Beaumont Hospital Symposium on Molecular Pathology. J. Mol. Diagn. 10: 383-395 [Abstract] [Full Text]  
• Palma, M. D., Domchek, S. M., Stopfer, J., Erlichman, J., Siegfried, J. D., Tigges-Cardwell, J., Mason, B. A., Rebbeck, T. R., Nathanson, K. L. (2008). The Relative Contribution of Point Mutations and Genomic Rearrangements in BRCA1 and BRCA2 in High-Risk Breast Cancer Families. Cancer Res. 68: 7006-7014 [Abstract] [Full Text]  
• Kauff, N. D., Domchek, S. M., Friebel, T. M., Robson, M. E., Lee, J., Garber, J. E., Isaacs, C., Evans, D. G., Lynch, H., Eeles, R. A., Neuhausen, S. L., Daly, M. B., Matloff, E., Blum, J. L., Sabbatini, P., Barakat, R. R., Hudis, C., Norton, L., Offit, K., Rebbeck, T. R. (2008). Risk-Reducing Salpingo-Oophorectomy for the Prevention of BRCA1- and BRCA2-Associated Breast and Gynecologic Cancer: A Multicenter, Prospective Study. JCO 26: 1331-1337 [Abstract] [Full Text]  
• Greene, M. H., Piedmonte, M., Alberts, D., Gail, M., Hensley, M., Miner, Z., Mai, P. L., Loud, J., Rodriguez, G., Basil, J., Boggess, J., Schwartz, P. E., Kelley, J. L., Wakeley, K. E., Minasian, L., Skates, S. (2008). A Prospective Study of Risk-Reducing Salpingo-oophorectomy and Longitudinal CA-125 Screening among Women at Increased Genetic Risk of Ovarian Cancer: Design and Baseline Characteristics: A Gynecologic Oncology Group Study. Cancer Epidemiol. Biomarkers Prev. 17: 594-604 [Abstract] [Full Text]  
• Lee, J. M., Kopans, D. B., McMahon, P. M., Halpern, E. F., Ryan, P. D., Weinstein, M. C., Gazelle, G. S. (2008). Breast Cancer Screening in BRCA1 Mutation Carriers: Effectiveness of MR Imaging--Markov Monte Carlo Decision Analysis. Radiology 246: 763-771 [Abstract] [Full Text]  
• Liu, S., Ginestier, C., Charafe-Jauffret, E., Foco, H., Kleer, C. G., Merajver, S. D., Dontu, G., Wicha, M. S. (2008). BRCA1 regulates human mammary stem/progenitor cell fate. Proc. Natl. Acad. Sci. USA 105: 1680-1685 [Abstract] [Full Text]  
• Devlin, L. A, Morrison, P. J (2008). Inherited gynaecological cancer syndromes. The Obstetrician and Gynaecologist 10: 9-15 [Abstract] [Full Text]  
• Fatouros, M., Baltoyiannis, G., Roukos, D. H. (2008). The Predominant Role of Surgery in the Prevention and New Trends in the Surgical Treatment of Women With BRCA1/2 Mutations. Ann. Surg. Oncol. 15: 21-33 [Abstract] [Full Text]  
• Huo, D., Olopade, O. I. (2007). Genetic Testing in Diverse Populations: Are Researchers Doing Enough to Get Out the Correct Message?. JAMA 298: 2910-2911 [Full Text]  
• Britt, K., Ashworth, A., Smalley, M. (2007). Pregnancy and the risk of breast cancer. Endocr Relat Cancer 14: 907-933 [Abstract] [Full Text]  
• Brohet, R. M., Goldgar, D. E., Easton, D. F., Antoniou, A. C., Andrieu, N., Chang-Claude, J., Peock, S., Eeles, R. A., Cook, M., Chu, C., Nogues, C., Lasset, C., Berthet, P., Meijers-Heijboer, H., Gerdes, A.-M., Olsson, H., Caldes, T., van Leeuwen, F. E., Rookus, M. A. (2007). Oral Contraceptives and Breast Cancer Risk in the International BRCA1/2 Carrier Cohort Study: A Report From EMBRACE, GENEPSO, GEO-HEBON, and the IBCCS Collaborating Group. JCO 25: 3831-3836 [Abstract] [Full Text]  
• Kuhl, C. K. (2007). Current Status of Breast MR Imaging * Part 2. Clinical Applications. Radiology 244: 672-691 [Abstract] [Full Text]  
• Lehman, C. D., Isaacs, C., Schnall, M. D., Pisano, E. D., Ascher, S. M., Weatherall, P. T., Bluemke, D. A., Bowen, D. J., Marcom, P. K., Armstrong, D. K., Domchek, S. M., Tomlinson, G., Skates, S. J., Gatsonis, C. (2007). Cancer Yield of Mammography, MR, and US in High-Risk Women: Prospective Multi-Institution Breast Cancer Screening Study. Radiology 244: 381-388 [Abstract] [Full Text]  
• Robson, M., Offit, K. (2007). Management of an Inherited Predisposition to Breast Cancer. NEJM 357: 154-162 [Full Text]  
• Fader, A. N., Rose, P. G. (2007). Role of Surgery in Ovarian Carcinoma. JCO 25: 2873-2883 [Abstract] [Full Text]  
• Kauff, N. D., Barakat, R. R. (2007). Risk-Reducing Salpingo-Oophorectomy in Patients With Germline Mutations in BRCA1 or BRCA2. JCO 25: 2921-2927 [Abstract] [Full Text]  
• Hoskins, W. J. (2007). How Should Women With a Genetic Predisposition for Cancer Be Managed?. Obstet Gynecol 110: 5-6 [Full Text]  
• Chen, L.-m., Yang, K. Y., Little, S. E., Cheung, M. K., Caughey, A. B. (2007). Gynecologic Cancer Prevention in Lynch Syndrome/Hereditary Nonpolyposis Colorectal Cancer Families. Obstet Gynecol 110: 18-25 [Abstract] [Full Text]  
• Karlan, B. Y., Berchuck, A., Mutch, D. (2007). The Role of Genetic Testing for Cancer Susceptibility in Gynecologic Practice. Obstet Gynecol 110: 155-167 [Abstract] [Full Text]  
• Jakubowska, A., Gronwald, J., Menkiszak, J., Gorski, B., Huzarski, T., Byrski, T., Edler, L., Lubinski, J., Scott, R. J, Hamann, U. (2007). Integrin {beta}3 Leu33Pro polymorphism increases BRCA1-associated ovarian cancer risk. J. Med. Genet. 44: 408-411 [Abstract] [Full Text]  
• Chang-Claude, J., Andrieu, N., Rookus, M., Brohet, R., Antoniou, A. C., Peock, S., Davidson, R., Izatt, L., Cole, T., Nogues, C., Luporsi, E., Huiart, L., Hoogerbrugge, N., Van Leeuwen, F. E., Osorio, A., Eyfjord, J., Radice, P., Goldgar, D. E., Easton, D. F., Epidemiological Study of Familial Breast Cancer (E, (2007). Age at Menarche and Menopause and Breast Cancer Risk in the International BRCA1/2 Carrier Cohort Study. Cancer Epidemiol. Biomarkers Prev. 16: 740-746 [Abstract] [Full Text]  
• Mabuchi, S., Altomare, D. A., Connolly, D. C., Klein-Szanto, A., Litwin, S., Hoelzle, M. K., Hensley, H. H., Hamilton, T. C., Testa, J. R. (2007). RAD001 (Everolimus) Delays Tumor Onset and Progression in a Transgenic Mouse Model of Ovarian Cancer. Cancer Res. 67: 2408-2413 [Abstract] [Full Text]  
• Kell, M. R, Burke, J. P (2007). Management of breast cancer in women with BRCA gene mutation. BMJ 334: 437-438 [Full Text]  
• Moscucci, O., Clarke, A. (2007). Prophylactic oophorectomy: a historical perspective. J. Epidemiol. Community Health 61: 182-184 [Abstract] [Full Text]  
• Lu, Y., Amleh, A., Sun, J., Jin, X., McCullough, S. D., Baer, R., Ren, D., Li, R., Hu, Y. (2007). Ubiquitination and Proteasome-Mediated Degradation of BRCA1 and BARD1 during Steroidogenesis in Human Ovarian Granulosa Cells. Mol. Endocrinol. 21: 651-663 [Abstract] [Full Text]  
• Crum, C. P., Drapkin, R., Kindelberger, D., Medeiros, F., Miron, A., Lee, Y. (2007). Lessons from BRCA: The Tubal Fimbria Emerges as an Origin for Pelvic Serous Cancer. Clin Med Res 5: 35-44 [Abstract] [Full Text]  
• Hwang, E. S., McLennan, J. L., Moore, D. H., Crawford, B. B., Esserman, L. J., Ziegler, J. L. (2007). Ductal Carcinoma In Situ in BRCA Mutation Carriers. JCO 25: 642-647 [Abstract] [Full Text]  
• Madalinska, J. B., van Beurden, M., Bleiker, E. M.A., Valdimarsdottir, H. B., Lubsen-Brandsma, L., Massuger, L. F., Mourits, M. J.E., Gaarenstroom, K. N., van Dorst, E. B.L., van der Putten, H., Boonstra, H., Aaronson, N. K. (2007). Predictors of Prophylactic Bilateral Salpingo-Oophorectomy Compared With Gynecologic Screening Use in BRCA1/2 Mutation Carriers. JCO 25: 301-307 [Abstract] [Full Text]  
• Weitzel, J. N., Buys, S. S., Sherman, W. H., Daniels, A. M., Ursin, G., Daniels, J. R., MacDonald, D. J., Blazer, K. R., Pike, M. C., Spicer, D. V. (2007). Reduced Mammographic Density with Use of a Gonadotropin-Releasing Hormone Agonist-Based Chemoprevention Regimen in BRCA1 Carriers. Clin. Cancer Res. 13: 654-658 [Abstract] [Full Text]  
• Gramling, R. E., Vidrine, J. I. (2007). Risk Communication During Screening for Genomic Breast Cancer Susceptibility. AMERICAN JOURNAL OF LIFESTYLE MEDICINE 1: 54-58 [Abstract]  
• Dorval, M., Vallee, M.-H., Plante, M., Chiquette, J., Gaudet, M., the Interdisciplinary Health Research Internationa, , Simard, J., the Interdisciplinary Health Research Internationa, (2007). Effect of the Women's Health Initiative Study Publication on Hormone Replacement Therapy Use among Women Who Have Undergone BRCA1/2 Testing. Cancer Epidemiol. Biomarkers Prev. 16: 157-160 [Abstract] [Full Text]  
• Ghosh, S., Lu, Y., Katz, A., Hu, Y., Li, R. (2007). Tumor suppressor BRCA1 inhibits a breast cancer-associated promoter of the aromatase gene (CYP19) in human adipose stromal cells. Am. J. Physiol. Endocrinol. Metab. 292: E246-E252 [Abstract] [Full Text]  
• Offit, K. (2006). BRCA Mutation Frequency and Penetrance: New Data, Old Debate. JNCI J Natl Cancer Inst 98: 1675-1677 [Full Text]  
• Guillem, J. G., Wood, W. C., Moley, J. F., Berchuck, A., Karlan, B. Y., Mutch, D. G., Gagel, R. F., Weitzel, J., Morrow, M., Weber, B. L., Giardiello, F., Rodriguez-Bigas, M. A., Church, J., Gruber, S., Offit, K. (2006). ASCO/SSO Review of Current Role of Risk-Reducing Surgery in Common Hereditary Cancer Syndromes. JCO 24: 4642-4660 [Abstract] [Full Text]  
• Guillem, J. G., Wood, W. C., Moley, J. F., Berchuck, A., Karlan, B. Y., Mutch, D. G., Gagel, R. F., Weitzel, J., Morrow, M., Weber, B. L., Giardiello, F., Rodriguez-Bigas, M. A., Church, J., Gruber, S., Offit, K. (2006). ASCO/SSO Review of Current Role of Risk-Reducing Surgery in Common Hereditary Cancer Syndromes. Ann. Surg. Oncol. 13: 1296-1321 [Abstract] [Full Text]  
• Schmeler, K. M., Sun, C. C., Bodurka, D. C., White, K. G., Soliman, P. T., Uyei, A. R., Erlichman, J. L., Arun, B. K., Daniels, M. S., Rimes, S. A., Peterson, S. K., Slomovitz, B. M., Milam, M. R., Gershenson, D. M., Lu, K. H. (2006). Prophylactic Bilateral Salpingo-Oophorectomy Compared With Surveillance in Women With BRCA Mutations.. Obstet Gynecol 108: 515-520 [Abstract] [Full Text]  
• Madalinska, J. B., van Beurden, M., Bleiker, E. M.A., Valdimarsdottir, H. B., Hollenstein, J., Massuger, L. F., Gaarenstroom, K. N., Mourits, M. J.E., Verheijen, R. H.M., van Dorst, E. B.L., van der Putten, H., van der Velden, K., Boonstra, H., Aaronson, N. K. (2006). The Impact of Hormone Replacement Therapy on Menopausal Symptoms in Younger High-Risk Women After Prophylactic Salpingo-Oophorectomy. JCO 24: 3576-3582 [Abstract] [Full Text]  
• Anderson, W. F., Matsuno, R. (2006). Breast cancer heterogeneity: a mixture of at least two main types?. JNCI J Natl Cancer Inst 98: 948-951 [Full Text]  
• Asselin-Labat, M.-L., Shackleton, M., Stingl, J., Vaillant, F., Forrest, N. C., Eaves, C. J., Visvader, J. E., Lindeman, G. J. (2006). Steroid hormone receptor status of mouse mammary stem cells.. JNCI J Natl Cancer Inst 98: 1011-1014 [Abstract] [Full Text]  
• Finch, A., Beiner, M., Lubinski, J., Lynch, H. T., Moller, P., Rosen, B., Murphy, J., Ghadirian, P., Friedman, E., Foulkes, W. D., Kim-Sing, C., Wagner, T., Tung, N., Couch, F., Stoppa-Lyonnet, D., Ainsworth, P., Daly, M., Pasini, B., Gershoni-Baruch, R., Eng, C., Olopade, O. I., McLennan, J., Karlan, B., Weitzel, J., Sun, P., Narod, S. A., for the Hereditary Ovarian Cancer Clinical Study G, (2006). Salpingo-oophorectomy and the Risk of Ovarian, Fallopian Tube, and Peritoneal Cancers in Women With a BRCA1 or BRCA2 Mutation. JAMA 296: 185-192 [Abstract] [Full Text]  
• Tiller, K., Meiser, B., Gaff, C., Kirk, J., Dudding, T., Phillips, K.-A., Friedlander, M., Tucker, K. (2006). A randomized controlled trial of a decision aid for women at increased risk of ovarian cancer.. Med Decis Making 26: 360-372 [Abstract]  
• Dean, M. (2006). CANCER STEM CELLS: Redefining the Paradigm of Cancer Treatment Strategies. Mol. Interv. 6: 140-148 [Abstract] [Full Text]  
• Bhoola, S., Hoskins, W. J. (2006). Diagnosis and management of epithelial ovarian cancer.. Obstet Gynecol 107: 1399-1410 [Abstract] [Full Text]  
• Hall, M. J., Olopade, O. I. (2006). Disparities in Genetic Testing: Thinking Outside the BRCA Box. JCO 24: 2197-2203 [Abstract] [Full Text]  
• Sonmezer, M., Oktay, K. (2006). Fertility preservation in young women undergoing breast cancer therapy.. The Oncologist 11: 422-434 [Abstract] [Full Text]  
• Walsh, T., Casadei, S., Coats, K. H., Swisher, E., Stray, S. M., Higgins, J., Roach, K. C., Mandell, J., Lee, M. K., Ciernikova, S., Foretova, L., Soucek, P., King, M.-C. (2006). Spectrum of Mutations in BRCA1, BRCA2, CHEK2, and TP53 in Families at High Risk of Breast Cancer. JAMA 295: 1379-1388 [Abstract] [Full Text]  
• Anderson, K., Jacobson, J. S., Heitjan, D. F., Zivin, J. G., Hershman, D., Neugut, A. I., Grann, V. R. (2006). Cost-effectiveness of preventive strategies for women with a BRCA1 or a BRCA2 mutation.. ANN INTERN MED 144: 397-406 [Abstract] [Full Text]  
• Simchoni, S., Friedman, E., Kaufman, B., Gershoni-Baruch, R., Orr-Urtreger, A., Kedar-Barnes, I., Shiri-Sverdlov, R., Dagan, E., Tsabari, S., Shohat, M., Catane, R., King, M.-C., Lahad, A., Levy-Lahad, E. (2006). Familial clustering of site-specific cancer risks associated with BRCA1 and BRCA2 mutations in the Ashkenazi Jewish population.. Proc. Natl. Acad. Sci. USA 103: 3770-3774 [Abstract] [Full Text]  
• Clarke, A., Chang, Y. M., McPherson, K. (2006). Removing organs "just in case"--is prophylactic removal of the ovaries a good thing?. J. Epidemiol. Community Health 60: 186-187 [Full Text]  
• Schmeler, K. M., Lynch, H. T., Chen, L.-m., Munsell, M. F., Soliman, P. T., Clark, M. B., Daniels, M. S., White, K. G., Boyd-Rogers, S. G., Conrad, P. G., Yang, K. Y., Rubin, M. M., Sun, C. C., Slomovitz, B. M., Gershenson, D. M., Lu, K. H. (2006). Prophylactic Surgery to Reduce the Risk of Gynecologic Cancers in the Lynch Syndrome. NEJM 354: 261-269 [Abstract] [Full Text]  
• Travis, L. B., Rabkin, C. S., Brown, L. M., Allan, J. M., Alter, B. P., Ambrosone, C. B., Begg, C. B., Caporaso, N., Chanock, S., DeMichele, A., Figg, W. D., Gospodarowicz, M. K., Hall, E. J., Hisada, M., Inskip, P., Kleinerman, R., Little, J. B., Malkin, D., Ng, A. K., Offit, K., Pui, C.-H., Robison, L. L., Rothman, N., Shields, P. G., Strong, L., Taniguchi, T., Tucker, M. A., Greene, M. H. (2006). Cancer Survivorship--Genetic Susceptibility and Second Primary Cancers: Research Strategies and Recommendations. JNCI J Natl Cancer Inst 98: 15-25 [Abstract] [Full Text]  
• Kramer, J. L., Velazquez, I. A., Chen, B. E., Rosenberg, P. S., Struewing, J. P., Greene, M. H. (2005). Prophylactic Oophorectomy Reduces Breast Cancer Penetrance During Prospective, Long-Term Follow-Up of BRCA1 Mutation Carriers. JCO 23: 8629-8635 [Abstract] [Full Text]  
• Rubinstein, W. S. (2005). Surgical Management of BRCA1 and BRCA2 Carriers: Bitter Choices Slightly Sweetened. JCO 23: 7772-7774 [Full Text]  
• Rebbeck, T. R., Friebel, T., Wagner, T., Lynch, H. T., Garber, J. E., Daly, M. B., Isaacs, C., Olopade, O. I., Neuhausen, S. L., van 't Veer, L., Eeles, R., Evans, D. G., Tomlinson, G., Matloff, E., Narod, S. A., Eisen, A., Domchek, S., Armstrong, K., Weber, B. L. (2005). Effect of Short-Term Hormone Replacement Therapy on Breast Cancer Risk Reduction After Bilateral Prophylactic Oophorectomy in BRCA1 and BRCA2 Mutation Carriers: The PROSE Study Group. JCO 23: 7804-7810 [Abstract] [Full Text]  
• Eisen, A., Lubinski, J., Klijn, J., Moller, P., Lynch, H. T., Offit, K., Weber, B., Rebbeck, T., Neuhausen, S. L., Ghadirian, P., Foulkes, W. D., Gershoni-Baruch, R., Friedman, E., Rennert, G., Wagner, T., Isaacs, C., Kim-Sing, C., Ainsworth, P., Sun, P., Narod, S. A. (2005). Breast Cancer Risk Following Bilateral Oophorectomy in BRCA1 and BRCA2 Mutation Carriers: An International Case-Control Study. JCO 23: 7491-7496 [Abstract] [Full Text]  
• Nanda, R., Schumm, L. P., Cummings, S., Fackenthal, J. D., Sveen, L., Ademuyiwa, F., Cobleigh, M., Esserman, L., Lindor, N. M., Neuhausen, S. L., Olopade, O. I. (2005). Genetic Testing in an Ethnically Diverse Cohort of High-Risk Women: A Comparative Analysis of BRCA1 and BRCA2 Mutations in American Families of European and African Ancestry. JAMA 294: 1925-1933 [Abstract] [Full Text]  
• Miller, S. M., Roussi, P., Daly, M. B., Buzaglo, J. S., Sherman, K., Godwin, A. K., Balshem, A., Atchison, M. E. (2005). Enhanced Counseling for Women Undergoing BRCA1/2 Testing: Impact on Subsequent Decision Making About Risk Reduction Behaviors. Health Educ Behav 32: 654-667 [Abstract]  
• Madalinska, J. B., Hollenstein, J., Bleiker, E., van Beurden, M., Valdimarsdottir, H. B., Massuger, L. F., Gaarenstroom, K. N., Mourits, M. J.E., Verheijen, R. H.M., van Dorst, E. B.L., van der Putten, H., van der Velden, K., Boonstra, H., Aaronson, N. K. (2005). Quality-of-Life Effects of Prophylactic Salpingo-Oophorectomy Versus Gynecologic Screening Among Women at Increased Risk of Hereditary Ovarian Cancer. JCO 23: 6890-6898 [Abstract] [Full Text]  
• Masciari, S., Garber, J. E. (2005). Quality or Quantity in the Management of Hereditary Ovarian Cancer Risk: Is It Really a Trade-Off?. JCO 23: 6817-6819 [Full Text]  
• Spencer, J A (2005). A multidisciplinary approach to ovarian cancer at diagnosis. Br. J. Radiol. 78: S94-S102 [Full Text]  
• U.S. Preventive Services Task Force*, (2005). Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility: Recommendation Statement. ANN INTERN MED 143: 355-361 [Abstract] [Full Text]  
• Nelson, H. D., Huffman, L. H., Fu, R., Harris, E. L. (2005). Genetic Risk Assessment and BRCA Mutation Testing for Breast and Ovarian Cancer Susceptibility: Systematic Evidence Review for the U.S. Preventive Services Task Force. ANN INTERN MED 143: 362-379 [Abstract] [Full Text]  
• Rosen, E M, Fan, S, Isaacs, C (2005). BRCA1 in hormonal carcinogenesis: basic and clinical research. Endocr Relat Cancer 12: 533-548 [Abstract] [Full Text]  
• Jacobs, I. (2005). Screening for Familial Ovarian Cancer: The Need for Well-Designed Prospective Studies. JCO 23: 5443-5445 [Full Text]  
• Stirling, D., Evans, D. G. R., Pichert, G., Shenton, A., Kirk, E. N., Rimmer, S., Steel, C. M., Lawson, S., Busby-Earle, R.M. C., Walker, J., Lalloo, F. I., Eccles, D. M., Lucassen, A. M., Porteous, M. E. (2005). Screening for Familial Ovarian Cancer: Failure of Current Protocols to Detect Ovarian Cancer at an Early Stage According to the International Federation of Gynecology and Obstetrics System. JCO 23: 5588-5596 [Abstract] [Full Text]  
• Kurian, A. W., Mills, M. A., Jaffee, M., Sigal, B. M., Chun, N. M., Kingham, K. E., Collins, L. C., Nowels, K. W., Plevritis, S. K., Garber, J. E., Ford, J. M., Hartman, A.-R. (2005). Ductal Lavage of Fluid-Yielding and Non-Fluid-Yielding Ducts in BRCA1 and BRCA2 Mutation Carriers and Other Women at High Inherited Breast Cancer Risk. Cancer Epidemiol. Biomarkers Prev. 14: 1082-1089 [Abstract] [Full Text]  
• Simeone, A.-M., Deng, C.-X., Kelloff, G. J., Steele, V. E., Johnson, M. M., Tari, A. M. (2005). N-(4-Hydroxyphenyl)retinamide is more potent than other phenylretinamides in inhibiting the growth of BRCA1-mutated breast cancer cells. Carcinogenesis 26: 1000-1007 [Abstract] [Full Text]  
• Xu, J., Fan, S., Rosen, E. M. (2005). Regulation of the Estrogen-Inducible Gene Expression Profile by the Breast Cancer Susceptibility Gene BRCA1. Endocrinology 146: 2031-2047 [Abstract] [Full Text]  
• Geiger, A. M., Yu, O., Herrinton, L. J., Barlow, W. E., Harris, E. L., Rolnick, S., Barton, M. B., Elmore, J. G., Fletcher, S. W. (2005). A Population-Based Study of Bilateral Prophylactic Mastectomy Efficacy in Women at Elevated Risk for Breast Cancer in Community Practices. Arch Intern Med 165: 516-520 [Abstract] [Full Text]  
• Narod, S. A., Offit, K. (2005). Prevention and Management of Hereditary Breast Cancer. JCO 23: 1656-1663 [Full Text]  
• Shaag, A., Walsh, T., Renbaum, P., Kirchhoff, T., Nafa, K., Shiovitz, S., Mandell, J. B., Welcsh, P., Lee, M. K., Ellis, N., Offit, K., Levy-Lahad, E., King, M.-C. (2005). Functional and genomic approaches reveal an ancient CHEK2 allele associated with breast cancer in the Ashkenazi Jewish population. Hum Mol Genet 14: 555-563 [Abstract] [Full Text]  
• Garber, J. E., Offit, K. (2005). Hereditary Cancer Predisposition Syndromes. JCO 23: 276-292 [Abstract] [Full Text]  
• Bertagnolli, M. M. (2005). Surgical Prevention of Cancer. JCO 23: 324-332 [Abstract] [Full Text]  
• Powell, C. B., Kenley, E., Chen, L.-m., Crawford, B., McLennan, J., Zaloudek, C., Komaromy, M., Beattie, M., Ziegler, J. (2005). Risk-Reducing Salpingo-Oophorectomy in BRCA Mutation Carriers: Role of Serial Sectioning in the Detection of Occult Malignancy. JCO 23: 127-132 [Abstract] [Full Text]  
• Cannistra, S. A. (2004). Cancer of the Ovary. NEJM 351: 2519-2529 [Full Text]  
• Wainberg, S., Husted, J. (2004). Utilization of Screening and Preventive Surgery Among Unaffected Carriers of a BRCA1 or BRCA2 Gene Mutation. Cancer Epidemiol. Biomarkers Prev. 13: 1989-1995 [Abstract] [Full Text]  
• Agnantis, N. J., Paraskevaidis, E., Roukos, D. (2004). Editorial: Preventing Breast, Ovarian Cancer in BRCA Carriers: Rational of Prophylactic Surgery and Promises of Surveillance. Ann. Surg. Oncol. 11: 1030-1034 [Full Text]  
• Oloparde, O. I. (2004). Genetics in Clinical Cancer Care: A Promise Unfulfilled among Minority Populations. Cancer Epidemiol. Biomarkers Prev. 13: 1683-1686 [Full Text]  
• Sifri, R., Gangadharappa, S., Acheson, L. S. (2004). Identifying and Testing for Hereditary Susceptibility to Common Cancers. CA Cancer J Clin 54: 309-326 [Abstract] [Full Text]  
• DiCioccio, R. A., Song, H., Waterfall, C., Kimura, M. T., Nagase, H., McGuire, V., Hogdall, E., Shah, M. N., Luben, R. N., Easton, D. F., Jacobs, I. J., Ponder, B. A.J., Whittemore, A. S., Gayther, S. A., Pharoah, P. D.P., Kruger-Kjaer, S. (2004). STK15 Polymorphisms and Association with Risk of Invasive Ovarian Cancer. Cancer Epidemiol. Biomarkers Prev. 13: 1589-1594 [Abstract] [Full Text]  
• Offit, K., Groeger, E., Turner, S., Wadsworth, E. A., Weiser, M. A. (2004). The "Duty to Warn" a Patient's Family Members About Hereditary Disease Risks. JAMA 292: 1469-1473 [Abstract] [Full Text]  
• Robson, M. E., Offit, K. (2004). Breast MRI for Women With Hereditary Cancer Risk. JAMA 292: 1368-1370 [Full Text]  
• Wacholder, S. (2004). Bias in Intervention Studies That Enroll Patients From High-Risk Clinics. JNCI J Natl Cancer Inst 96: 1204-1207 [Abstract] [Full Text]  
• Kriege, M., Brekelmans, C. T.M., Boetes, C., Besnard, P. E., Zonderland, H. M., Obdeijn, I. M., Manoliu, R. A., Kok, T., Peterse, H., Tilanus-Linthorst, M. M.A., Muller, S. H., Meijer, S., Oosterwijk, J. C., Beex, L. V.A.M., Tollenaar, R. A.E.M., de Koning, H. J., Rutgers, E. J.T., Klijn, J. G.M., the Magnetic Resonance Imaging Screening Study Gro, (2004). Efficacy of MRI and Mammography for Breast-Cancer Screening in Women with a Familial or Genetic Predisposition. NEJM 351: 427-437 [Abstract] [Full Text]  
• Blazer, K R, Grant, M, Sand, S R, MacDonald, D J, Uman, G C, Weitzel, J N (2004). Effects of a cancer genetics education programme on clinician knowledge and practice. J. Med. Genet. 41: 518-522 [Abstract] [Full Text]  
• Daly, M. B. (2004). Tailoring Breast Cancer Treatment to Genetic Status: The Challenges Ahead. JCO 22: 1776-1777 [Full Text]  
• Schwartz, M. D., Lerman, C., Brogan, B., Peshkin, B. N., Hughes Halbert, C., DeMarco, T., Lawrence, W., Main, D., Finch, C., Magnant, C., Pennanen, M., Tsangaris, T., Willey, S., Isaacs, C. (2004). Impact of BRCA1/BRCA2 Counseling and Testing on Newly Diagnosed Breast Cancer Patients. JCO 22: 1823-1829 [Abstract] [Full Text]  
• Sonmezer, M., Oktay, K. (2004). Fertility preservation in female patients. Hum Reprod Update 10: 251-266 [Abstract] [Full Text]  
• Hogg, R., Friedlander, M. (2004). Biology of Epithelial Ovarian Cancer: Implications for Screening Women at High Genetic Risk. JCO 22: 1315-1327 [Abstract] [Full Text]  
• Jacobs, I. J., Menon, U. (2004). Progress and Challenges in Screening for Early Detection of Ovarian Cancer. Mol. Cell. Proteomics 3: 355-366 [Abstract] [Full Text]  
• Balmana, J, Stoffel, E M, Emmons, K M, Garber, J E, Syngal, S (2004). Comparison of motivations and concerns for genetic testing in hereditary colorectal and breast cancer syndromes. J. Med. Genet. 41: e44-e44 [Full Text]  
• Hartmann, L. C., Degnim, A., Schaid, D. J. (2004). Prophylactic Mastectomy for BRCA1/2 Carriers: Progress and More Questions. JCO 22: 981-983 [Full Text]  
• Garber, J. E., Hartman, A.-R. (2004). Prophylactic Oophorectomy and Hormone Replacement Therapy: Protection at What Price?. JCO 22: 978-980 [Full Text]  
• Thull, D. L., Vogel, V. G. (2004). Recognition and Management of Hereditary Breast Cancer Syndromes. The Oncologist 9: 13-24 [Abstract] [Full Text]  
• Peshkin, B. N., Isaacs, C., Finch, C., Kent, S., Schwartz, M. D. (2003). Tamoxifen As Chemoprevention in BRCA1 and BRCA2 Mutation Carriers With Breast Cancer: A Pilot Survey of Physicians. JCO 21: 4322-4328 [Abstract] [Full Text]  
• Weitzel, J. N., McCaffrey, S. M., Nedelcu, R., MacDonald, D. J., Blazer, K. R., Cullinane, C. A. (2003). Effect of Genetic Cancer Risk Assessment on Surgical Decisions at Breast Cancer Diagnosis. Arch Surg 138: 1323-1328 [Abstract] [Full Text]  
• Levine, D. A., Argenta, P. A., Yee, C. J., Marshall, D. S., Olvera, N., Bogomolniy, F., Rahaman, J. A., Robson, M. E., Offit, K., Barakat, R. R., Soslow, R. A., Boyd, J. (2003). Fallopian Tube and Primary Peritoneal Carcinomas Associated With BRCA Mutations. JCO 21: 4222-4227 [Abstract] [Full Text]  
• Foulkes, W. D., Narod, S. A., Swenerton, K., Panabaker, K., Gilbert, L. (2003). Re: Gynecologic Surgeries and Risk of Ovarian Cancer in Women with BRCA1 and BRCA2 Ashkenazi Founder Mutations: An Israeli Population-Based Case-Control Study. JNCI J Natl Cancer Inst 95: 1640-1640 [Full Text]  
• Schwartz, M. D., Kaufman, E., Peshkin, B. N., Isaacs, C., Hughes, C., DeMarco, T., Finch, C., Lerman, C. (2003). Bilateral Prophylactic Oophorectomy and Ovarian Cancer Screening Following BRCA1/BRCA2 Mutation Testing. JCO 21: 4034-4041 [Abstract] [Full Text]