Prophylactic Surgery May Be Too Late for Ovarian Ca.

Five of 60 women had disease at surgery.

NASHVILLE, TENN. -- For women at high risk of developing ovarian cancer, prophylactic oophorectomy may sometimes come too late.

And a full hysterectomy, in addition to a bilateral salpingo-oophorectomy, should be the standard of care for these at-risk patients, Dr. Joan Murphy said at the annual meeting of the Society for Gynecologic Oncology.

In a study of 60 patients with a BRCAI mutation who underwent the procedure at about 48 years of age, 5 patients already had the disease. Four of the cancers were invasive; one was carcinoma in situ.

"There's growing evidence that this is becoming an issue, and I think we have probably underplayed it," said Dr. Murphy one of the study investigators and head of the division of gynecologic oncology at the Familial Ovarian Cancer Center, Princess Margaret Hospital, Toronto.

"Although this procedure is prophylactic and we go into it believing that these women are well, in all five of our cases it's come as a terrible shock to them to find out they already had cancer," she told this newspaper.

Dr. Murphy strongly advised very careful preoperative counseling of these women, suggesting that most physicians in this field may be underestimating the risks of finding an occult cancer.