Hereditary Breast and Ovarian Cancer Syndrome

Background Information

• 10% of ovarian cancer is genetic• 5% of breast cancer is genetic• BRCA 1 and 2

BRCA

• Incidence is 1 out of 300-800 in the general population

• BRCA 1 pos risk of ovarian cancer is 39-46% and risk of breast cancer is 65-75%

• BRCA 2 pos risk of ovarian cancer is 12-20% and risk of breast cancer is 65-75%

• BRCA pos ovarian cancer is mainly high grade serous or endometroid

20-25% Chance of BRCA pos

• PH of both breast and ovarian cancer• PH of ovarian cancer and 1 close relative with

ovarian cancer or premenopausal breast cancer

• PH of breast cancer <50 and close relative with ovarian cancer or male breast cancer any age

• FH of close relative that is BRCA pos

5-10% Chance of BRCA

• PH breast cancer <40 years• PH of high grade serous ovarian cancer any

age• PH of bilateral breast cancer• PH of breast cancer <50 yrs and close relative

with breast cancer <50 yrs• PH of breast cancer any age and 2 close

relatives with breast cancer any age

What to do if BRCA pos?

• Ca 125 and pelvic ultrasound beginning age 30-35

• Use birth control pills for contraception• Prophylactic BSO– Ovarian cancer reduction 90%– Breast cancer reduction 40-70%

• Prophylactic mastectomy– 90-95% reduction

What to do if BRCA pos?

• Breast MRI annually at age 25• Tamoxifen– Only helps BRCA 2 with reduction of 60%

Salpingectomy for Prevention of Ovarian Cancer in Low Risk Populations

Should the fallopian tube be removed and leave the ovaries?

• Concern regarding reduced ovarian function when you remove the tube

• Preserving the ovaries would benefit woman when it comes to bone health and cardiovascular disease

• Total salpingectomy is not reversible

Vulvodynia

Formerly known as Vestibulitis or Vestibular Adenitis

Clinical Triad

• Entrance dysparunia• Recurrent bouts of vaginitis• Chronic UTI episodes or symptoms

Physical Exam

• Initial inspection to look for dermatologic causes of pain

• Map tender areas with a Q-tip• Speculum exam to look for atrophy or vaginitis• Single digit exam to isolate areas of

tenderness• Bimanual exam to determine if there is

cervical, uterine, or adenexal tenderness

Treatment

• Avoid vulvar irritants• Mid potency corticosteroid ointment• Topical lidocaine 5% ointment• Tricyclic antidepressants• Gabapentin• Topical estrogen• Pelvic floor relaxation