Ovarian cancer risk management in BRCA-mutation carriers: A comparison of six international and national guidelines.

OBJECTIVE: Germline mutations in the BRCA gene account for most hereditary ovarian and breast cancer. Management of healthy carriers aims to prevent and allow early detection of breast and ovarian cancer. This study compares six different hereditary ovarian cancer management guidelines, highlighting areas of controversy between different societies. We aim to compare international and national guidelines regarding BRCA carriers' management. STUDY DESIGN: A comparative study. We retrieved, reviewed, and compared the most recent guidelines of BRCA mutation carriers from the specializing societies NCCN (National Comprehensive National network) and ESMO (European society of medical oncology), and national societies of the United States (American College of Obstetricians and Gynecologists), England (the Royal College of Obstetricians and Gynecologists), Canada (the Society of Obstetricians and Gynaecologists of Canada) and Spain (Sociedad Española de Oncología Médica). RESULTS: There is a broad consensus regarding the limited role of screening for early ovarian cancer detection (4 out of 6) (4/6) and regarding the recommendation for implementation of Risk-reducing salpingo-oophorectomy (RRSO) (6/6), some variations exist for age at RRSO. It is widely accepted that risk reducing salpingectomy should be performed only as part of research (5/6), and that the addition of risk-reducing hysterectomy should be individualized (3/6). Not all guidelines address fertility issues, and controversy exists regarding hormone replacement therapy (HRT) recommendations in unaffected young BRCA-mutation carriers following RRSO. CONCLUSION: BRCA carrier's management guidelines consist of well-agreed topics such as the ineffective screening for early detection of ovarian cancer and the recommendation of RRSO. HRT remains controversial. Conforming unified recommendations is needed for providing evidence-based recommendations.

Predicting success of methotrexate treatment by pretreatment HCG level and 24-hour HCG increment.

OBJECTIVE: To evaluate ß-human chorionic gonadotropin (ß-HCG) level and its 24-hour increment as predictors of successful methotrexate treatment for ectopic pregnancy. METHODS: Data were retrospectively reviewed from women with ectopic pregnancy who were treated by single-dose methotrexate (50 mg/m2 ) at a university hospital in Jerusalem, Israel, between January 1, 2000, and June 30, 2015. Serum ß-HCG before treatment and its percentage increment in the 24 hours before treatment were compared between treatment success and failure groups. RESULTS: Sixty-nine women were included in the study. Single-dose methotrexate treatment was successful for 44 (63.8%) women. Both mean ß-HCG level and its 24-hour increment were lower for women with successful treatment than for those with failed treatment (respectively, 1224 IU\L vs 2362 IU\L, P=0.018; and 13.5% vs 29.6%, P=0.009). Receiver operator characteristic curve analysis yielded cutoff values of 1600 IU\L and 14% increment with a positive predictive value of 75% and 82%, respectively, for treatment success. ß-HCG level and its 24-hour increment were independent predictors of treatment outcome by logistic regression (both P<0.01). CONCLUSIONS: A ß-HCG increment of less than 14% in the 24 hours before single-dose methotrexate and serum ß-HCG of less than 1600 IU\L were found to be good predictors of treatment success.