Ovarian/Tubal Pathology in Premenopausal Women with Breast Cancer: A Prospective Study

Breast cancer is most common cancer among women and hereditary mutations account for 5-10%. HBOC syndrome is most common hereditary mutation affecting breast & ovary. The prevalence of STIC lesions in these women ranges from 2 to 12% and that in general population is unknown. Role of risk reduction salpingo-oophorectomy (RRSO) is well established among these women. Surgical ovarian ablation also plays role in hormone positive breast cancers in prolonging their survival by permanent hormone suppression. The role of oophorectomy has different impacts in breast cancer.

The study aimed to determine the different indications for oophorectomy and their histologies among premenopausal breast cancer women. This was a prospective cross sectional study of breast cancer women diagnosed ≤ 50 years of age. All these women underwent genetic counselling, gynaecology examination, transvaginal scan &CA 125 testing. Surgery was offered to women with BRCA mutations (RRSO) and also for hormone receptor positive women (surgical ovarian ablation). Histopathologies of these women were analysed using SEE-FIM protocol.

A total of 98 breast cancer women were identified. The median age was 41.5 years (SD 5.7) & median CA 125 was 9.3 (IQR 6-20.5). The genetic acceptance rate was 18%. Four patients were germline BRCA 1/2 positive, 1 VUS, 13 negative and 80 didn't opt for test. Ultrasound imaging showed cystic ovaries among 12 patients. Most of them had benign features. Twenty two patients underwent surgery (bilateral salpingo-oophorectomy)-3 BRCA positive and rest for hormone positive breast cancer. Histopathologies were normal except for Krukenberg's mets in one hormone positive breast cancer patient.

The incidence of germline mutations in our study was 5%. STIC lesions were not detected in our study, attributing to low acceptance of genetic testing. The value of screening for ovarian cancer was limited. Incorporation of genetics into routine gynaecology oncology clinic needs further addressal. Our study opened the doors for the genetic awareness among these young women.