Proefschrift Majke van Bommel
Dr. Majke van Bommel heeft afgelopen 22 november succesvol haar proefschrift verdedigd aan de Radboud Universiteit. Haar proefschrift is getiteld ‘Optimizing risk-reducing care for women at high inherited risk of ovarian cancer – the potential of the fallopian tubes’ en gaat over de mogelijkheid van een tubectomie met uitgestelde ovariëctomie als preventieve optie voor vrouwen met verhoogd risico op ovariumcarcinoom.
Female carriers of a BRCA1/2 pathogenic variant are at increased risk for ovarian cancer and current screening strategies are proven not to be effective. Therefore, they are advised to undergo a risk-reducing salpingo-oophorectomy around the age of 40. This surgery greatly reduces the risk of ovarian cancer, yet induces early surgical menopause of which many women experience complaints. Research has shown that ovarian cancer often originates in the fallopian tubes, rather than in the ovaries. In this thesis, a novel method to prevent ovarian cancer is studied; removal of the fallopian tubes first (salpingectomy) and the ovaries later (delayed oophorectomy). Until three years after surgery, women after the novel method were more satisfied with their menopause-related quality of life compared to women who underwent salpingo-oophorectomy; also when using hormone replacement therapy post-surgery. An international study has been started to investigate whether both methods are equally safe (TUBA-WISP II study).
In this thesis also other topics related to ovarian cancer were studied. Regarding the precursor lesion of ovarian cancer in the fallopian tube, a STIC, we found that women with STIC at preventive surgery have an extremely increased risk of developing peritoneal cancer later on compared to women without a STIC. Regarding ovarian cancer itself, we found that 17% of all ovarian cancers are related to BRCA1/2 pathogenic variant carriership and that these pathogenic variants were found in all types of ovarian cancer. Further, the oral contraceptive pill probably increases the risk of breast cancer among BRCA1/2 pathogenic variant carriers, whereas it decreases ovarian cancer risk. Tubal ligation appeared to decrease ovarian cancer risk as well.
