Acceptability of prophylactic salpingectomy with delayed oophorectomy as risk-reducing surgery among BRCA mutation carriers

Abstract

OBJECTIVE Given emerging evidence for the fimbria as the site of origin for many serous carcinomas in BRCA mutation carriers, consideration is being given to studying prophylactic salpingectomy with delayed oophorectomy (PSDO) as risk-reducing surgery. We aimed to determine the interest in a study of PSDO among these women. METHODS We evaluated the results of an online survey conducted by Facing Our Risk of Cancer Empowered (FORCE), a patient advocacy group, from October 2010 to August 2012. Premenopausal BRCA mutation carriers with no history of ovarian cancer or prior bilateral salpingo-oophorectomy (BSO) were included. RESULTS Of the 204 women meeting inclusion criteria, median age was 35 years, 92.5% were white, 25.7% Jewish, and 16.7% had a history of breast cancer. Overall, 34.3% reported interest in a study of salpingectomy, 35.3% were unsure, and 30.4% were not interested in the study. Women noted the possibility of lowering ovarian cancer risk without menopause as a compelling reason to participate (83.8%). Reasons for not participating in a salpingectomy study included surgical complications (46.6%), potential ovarian damage (42.2%), planning BSO soon (32.4%), and surgical costs (32.8%). Acceptable study risks included the need for two surgeries (77.2%), possibility of not lowering ovarian cancer risk (68%), and disruption of ovarian blood supply (66.5%). CONCLUSIONS One-third of BRCA mutation carriers indicated definite interest in a PSDO study. Potential study risks were acceptable to most women. These findings suggest that patient accrual for a clinical trial of prophylactic salpingectomy with delayed oophorectomy is possible.

Risk reducing salpingectomy and delayed oophorectomy in high risk women: views of cancer geneticists, genetic counsellors and gynaecological oncologists in the UK

“…[34,43,44] The top ranked barrier was lack of evidence of level of risk benefit obtained from RRS. While the tube is an extremely important piece of the puzzle, it does not explain the entire picture.…”

“…Of note, two-thirds of BRCA carriers in a study from the USA found the risks associated with the need for two surgeries, possibility of not lowering ovarian cancer risk, and potential disruption of ovarian blood supply to be acceptable. [44] There is need to understand the views of high risk women in the UK too.…”

“…Interest amongst BRCA carriers in participating in a RRSDO study/trial has been reported. [43,44] A clinical trial led by LeBlanc [32] is currently underway in France, evaluating Radical Fimbriectomy in BRCA1/2 carriers (NCT01608074) and one is being initiated at MD Anderson in the USA comparing self selected RRSO and RRSDO and screening, with the primary outcome measure being patient compliance with DO at 3 year follow up (NCT01907789). A randomised trial comparing RRSDO with RRSO does not seem feasible given there is no data to support equipoise in outcomes between the two options.…”

Ovarian Cancer Prevention in High-risk Women

“…Salpingectomy with delayed oophorectomy has been proposed as an alternative to RRSO in order to postpone the onset of premature menopause and its effect on non-cancer menopause-related morbidity and quality of life(116). Modeling of the cost-effectiveness of this approach demonstrated acceptability and a survey of previvors and key stakeholders demonstrated interest and acceptability of this approach (117, 118). Several prospective studies are in various phases of development and patient accrual (119, 120).…”

Managing symptoms and maximizing quality of life after preventive interventions for cancer risk reduction

“…However, even if prophylactic salpingectomy proves to provide optimal gynaecologic cancer risk reduction, preservation of the ovaries will not confer the same breast cancer risk reduction and should be factored into patient counselling. In a study looking at acceptability of prophylactic salpingectomy with delayed oophorectomy, the patient's primary concerns in participation were related to surgical complications, ovarian damage and costs [11].…”