Surveillance Of Women At High Risk Of Gynecological Cancers: 10 Year Results From One Center

Women at high risk of ovarian or endometrial cancers are recommended to be under programmed surveillance once a year. The efficiency of the follow-up has not been proved. The role of screening instead of prophylactic surgery has been questionable. 137 women have been followed according to recommended surveillance program at the gynaecological oncology unit at Oulu University Hospital for ten years.The outcome of the women has been analyzed for surveillance indication, prophylactic operations and diagnosed cancers. The main indication for surveillance was a family history of breast and ovarian cancer (39%), breast cancer at young age (19%), HNPCC mutation (20%) and BRCA1 or BRCA2 mutation (14%). Prophylactic surgery was performed on 16 women (12%): Eight hysterectomies with salphingo-oophorectomies, six salphingooophorectomies and two mastectomies. During the surveillance period 19 cancers and two premalignant lesions were found. Seven breast cancers, two endometrium cancers, one ovarian cancer, one endocervical cancer, five colorectal cancers and three miscellaneous cancers ( sarcoma, leucaemia, skin cancer). 60% of the breast cancers and 80% of the colorectal cancers were diagnosed in their advanced stage. In contrast, endometrial-, ovarianand cervical adenocarcinomas were diagnosed as local tumors in their early stage. 70% of the cancers were found during the first two years of the surveillance period. It is obvious that the screening program for women at high risk of gynaecological cancers is appropriate but the role of prophylactic mastectomy should be more emphasized as breast cancer prevention.