TY - THES

T1 - Beyond risk-reducing salpingo-oophorectomy

T2 - On breast cancer risk and bone health

AU - Fakkert, Ingrid Elizabeth

PY - 2017

Y1 - 2017

N2 - Risk-reducing salpingo-oophorectomy (RRSO) at premenopausal age is advised to women with elevated ovarian cancer risks due to germline BRCA1/2 mutations. Physical and psychosexual health effects associated with menopause are expected to occur earlier and more severe after surgical menopause induced by premenopausal RRSO than after natural menopause. Within these RRSO-induced health effects, this thesis investigated breast cancer risk and bone health.Previous studies reported a 50% breast cancer risk reduction after RRSO in BRCA1/2 mutation carriers. In our study of breast cancer screening effectiveness after premenopausal RRSO, we could not confirm this risk reduction. Also others have challenged the evidence on a RRSO-induced breast cancer risk reduction and it is postulated that previously reported risk reductions resulted from bias. More research is needed and meanwhile, intensive breast cancer screening remains warranted after RRSO.After natural menopause, bone mineral density (BMD) decreases and fracture risk increases. In a systematic review and meta-analysis on surgical menopause in a general population, BMD was lower in women with surgical menopause than in age-matched premenopausal women, but comparable to age-matched women with natural menopause. In our study in women with elevated ovarian cancer risk, BMD and fracture risk were comparable to general population data five years after RRSO, but bone turnover markers (BTMs) were elevated. Because elevated BTMs may predict increased fracture risk later in life, prospective longitudinal research is needed to evaluate long-term implications of elevated BTMs after RRSO.These results can be used to improve care for women during counselling and after RRSO.

AB - Risk-reducing salpingo-oophorectomy (RRSO) at premenopausal age is advised to women with elevated ovarian cancer risks due to germline BRCA1/2 mutations. Physical and psychosexual health effects associated with menopause are expected to occur earlier and more severe after surgical menopause induced by premenopausal RRSO than after natural menopause. Within these RRSO-induced health effects, this thesis investigated breast cancer risk and bone health.Previous studies reported a 50% breast cancer risk reduction after RRSO in BRCA1/2 mutation carriers. In our study of breast cancer screening effectiveness after premenopausal RRSO, we could not confirm this risk reduction. Also others have challenged the evidence on a RRSO-induced breast cancer risk reduction and it is postulated that previously reported risk reductions resulted from bias. More research is needed and meanwhile, intensive breast cancer screening remains warranted after RRSO.After natural menopause, bone mineral density (BMD) decreases and fracture risk increases. In a systematic review and meta-analysis on surgical menopause in a general population, BMD was lower in women with surgical menopause than in age-matched premenopausal women, but comparable to age-matched women with natural menopause. In our study in women with elevated ovarian cancer risk, BMD and fracture risk were comparable to general population data five years after RRSO, but bone turnover markers (BTMs) were elevated. Because elevated BTMs may predict increased fracture risk later in life, prospective longitudinal research is needed to evaluate long-term implications of elevated BTMs after RRSO.These results can be used to improve care for women during counselling and after RRSO.

M3 - Thesis fully internal (DIV)

SN - 978-94-034-0077-8

PB - Rijksuniversiteit Groningen

CY - [Groningen]

ER -