1. Hereditary Breast and Ovarian Cancer Syndrome

2. Background Information 10% of ovarian cancer is genetic 5% of breast cancer is genetic BRCA 1 and 2

3. 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

4. 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. 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

6. 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

7. What to do if BRCA pos? Breast MRI annually at age 25 Tamoxifen – Only helps BRCA 2 with reduction of 60%

8. Salpingectomy for Prevention of Ovarian Cancer in Low Risk Populations

9. 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

10. Vulvodynia Formerly known as Vestibulitis or Vestibular Adenitis

11. Clinical Triad Entrance dysparunia Recurrent bouts of vaginitis Chronic UTI episodes or symptoms

13. 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

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