Simple cysts do not require follow-up

 

Evaluating an Asymptomatic Adnexal Cyst Found on Pelvic Ultrasonography

https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2714297

“It is well recognized that simple adnexal cysts (thin-walled round or oval cysts with anechoic fluid and through transmission) are almost always benign, but there is hesitancy to ignore these common cysts and not recommend follow-up, particularly when cysts are large or when the patient is postmenopausal.

This study determines the risk for malignant ovarian cancer based on ultrasonographic characteristics of masses in the ovaries, including simple cysts. The researchers enrolled 72,093 women who underwent pelvic ultrasonography and identified 210 who were consequently diagnosed with ovarian cancer.

Normal ovaries were observed in most women. A simple cyst was the second most common ovarian finding among participants after a normal ovary. Nearly 25% of participants younger than 50 years had a simple cyst, as did 13% of women aged 50 years and older.

There was no significantly elevated risk for ovarian cancer among women with simple cysts both older and younger than 50 years compared with those with normal ovaries.

Simple cysts are frequently encountered incidental and normal findings on pelvic imaging, and additional evaluation of these findings is not warranted.”  

Lynch cancer syndrome is as common as BRCA1/2 yet is under-diagnosed

"Keys to identifying Lynch syndrome"

http://www.contemporaryobgyn.net/gynecologic-cancers/keys-identifying-lynch-syndrome

“Lynch syndrome is an autosomal-dominant hereditary cancer syndrome that has the same incidence in the general population as the BRCA1/2gene cancer syndrome: 1 in 400 people. Lynch syndrome is not rare, and yet it is under-diagnosed, only about 5% of Lynch syndrome carriers have been identified. The predominant risk associated is colon cancer.

Lynch syndrome is caused by a mutation in a DNA mismatch repair pathway.

Usually, our healthy genes can detect mistaken genes and repair them as they are growing and multiplying. However, with Lynch syndrome, the healthy cells cannot repair the errant cells, and the body continues to make more flawed cells, which will lead to a cancer.

A study from MD Anderson in 2005 reported that up to 71% of women identified as having Lynch syndrome will acquire endometrial cancer (20% risk by age 50) and 12% will acquire ovarian cancer. For these women, mean age at diagnosis of colorectal cancer was 40 and at diagnosis of endometrial or ovarian cancer was 44.

Obstet Gynecol. 2005;105:569-574

A woman who presents with abnormal uterine bleeding and has a family history of colorectal cancer could be at risk for having Lynch syndrome, particularly if the affected member is younger than age 50. Taking a careful cancer family history is the most effective way for a clinician to evaluate a patient for risk of having Lynch syndrome. Ordering a hereditary cancer screen that will test for multiple cancer syndromes at one time is now the standard of care.

Once a patient with Lynch syndrome has completed childbearing, it is appropriate to counsel her to consider a prophylactic hysterectomy and bilateral salpingo-oophorectomy”.

 Lynch syndrome. Because you deserve to know.

Ultrasound screening for ovarian cancer: high cost and low precision.

“Survival of Women With Type I and II Epithelial Ovarian Cancer Detected by Ultrasound Screening”

Obstetrics and Gynecology 132(5):1089-1090, November 2018

 “The University of Kentucky Ovarian Cancer Screening Trial was initiated in 1987 to determine the effect of annual trans vaginal ultrasonography on stage at detection and ovarian cancer mortality.  Since that time, free screening has been provided to more than 46,000 women (at high risk due to familial factors). 

Unscreened women with clinically detected epithelial ovarian cancer referred to the University of Kentucky-Markey Cancer Center for treatment from 1995 to 2017 served as the control group for this investigation.

Women who had a normal screen were scheduled to return in 12 months for a repeat screen. Women who had an abnormal screen underwent a repeat ultrasound examination in 4–6 weeks. Criteria for abnormality included an ovarian volume greater than 20cm³for premenopausal women and greater than 10 cm³ for postmenopausal women. 

A total of 699 women (1.5%) with persisting ovarian tumors on trans vaginal ultrasonography underwent surgery. Seventy-one women with invasive epithelial ovarian cancer were detected. (Precision 0.101)

Twenty-six women (37%) in the screening group had stage III ovarian cancer at the time of detection as compared with 70% of women in the unscreened group with stage III or IV.  The 10-year ovarian cancer mortality was reduced in women receiving screening by 31% and produced 416 life years gained at a cost of $40,851 per life year gained”. ($17M)

Do women suffer brain injury after ovarian surgery?

"every action has a reaction"

"Association of Bilateral Salpingo-Oophorectomy Before Menopause Onset With Medial Temporal Lobe Neurodegeneration"

jamaneurol.2018.3057

“Women who undergo bilateral salpingo-oophorectomy (BSO) before the onset of menopause have an accelerated accumulation of multimorbidity, with an increased risk of aging-associated neurological diseases, including dementia

Premenopausal oophorectomy–induced oestrogen deficiency is thought to be the primary cause of the increased risk of cognitive impairment or dementia in women with BSO before the onset of menopause.  Alzheimer Disease (AD) biomarker abnormalities have been observed more frequently in women undergoing menopause compared with premenopausal women, after controlling for age.

Neurology. 2007;69(11):1074-1083

In our study, 96% of the women with BSO were treated with estrogen (primarily oral conjugated equine estrogen), for a median of 10 years after BSO; however, this type and duration of hormonal treatment after BSO does not seem to be sufficient to prevent structural changes in the medial temporal lobe later in life.

In this study, women who underwent BSO before age 50 years and before reaching natural menopause had smaller amygdala volumes, thinner parahippocampal-entorhinal cortices, and lower entorhinal white matter fractional anisotropy values compared with control-participant women.

Abrupt hormonal changes because of BSO in premenopausal women may lead to medial temporal lobe structural abnormalities later in life. Because alterations in structural imaging biomarkers of neuro-degeneration in the medial temporal lobe precede clinical symptoms of dementia, enlargement and longitudinal follow-up of this cohort is needed ‘'.