Psychosocial factors and uptake of risk-reducing salpingo-oophorectomy in women at high risk for ovarian cancer

Abstract

Objective: Bilateral risk-reducing salpingo-oophorectomy (RRSO) has been shown to significantly reduce the risk of ovarian cancer. This study assessed factors predicting uptake of RRSO.Methods/materials: Women participating in a large multiple-case breast cancer family cohort study who were at increased risk for ovarian and fallopian tube cancer (i.e. BRCA1 or BRCA2 mutation carrier or family history including at least one firstor second-degree relative with ovarian or fallopian tube cancer), with no personal history of cancer and with at least one ovary in situ at cohort enrolment, were eligible for this study. Women who knew they did not carry the BRCA1 or BRCA2 mutation segregating in their family (true negatives) were excluded. Sociodemographic, biological and psychosocial factors, including cancer-specific anxiety, perceived ovarian cancer risk, optimism and social support, were assessed using selfadministered questionnaires and interviews at cohort enrolment. RRSO uptake was self-reported every three years during systematic follow-up. Results:Of 2,859 women, 571 were eligible. Mean age was 43.3 years; 62 women (10.9%) had RRSO a median of two years after cohort entry. Factors predicting RRSO were: being parous (OR 3.3, p=0.015); knowing one's mutation positive status (OR 2.9, p<0.001) and having a mother and/or sister who died from ovarian cancer (OR 2.5, p=0.013). Psychological variables measured at cohort entry were not associated with RRSO.Discussion: These results suggest that women at high risk for ovarian cancer make decisions about RRSO based on risk and individual socio-demographic characteristics, rather than in response to psychological factors such as anxiety.

Factors associated with deciding between risk-reducing salpingo-oophorectomy and ovarian cancer screening among high-risk women enrolled in GOG-0199: An NRG Oncology/Gynecologic Oncology Group study

“…Similar to previous reports [22], participants in our study who chose RRSO were more likely to be BRCA mutation carriers and to have had a personal history of cancer. They were also more likely to perceive that surgical risks and complications, potential effects of RRSO on their sex life, reaching the age at which their female relatives developed cancer, and the anxiety associated with frequent screening tests influenced their choice.…”

“…The decision between these modalities has been shown to be influenced by individual women’s demographic characteristics as well as personal preferences and values [11, 22–26]. …”

Preventing breast and ovarian cancers in high‐risk BRCA1 and BRCA2 mutation carriers

“…Greater uptake of RRBSO is associated with lower educational level, parity, being married, having a family history of ovarian cancer, perceiving a greater cancer risk and cancer‐related anxiety or fear 19 . Fear of the adverse effects of premature menopause may explain the reluctance to undergo RRBSO.…”

Timing and context: important considerations in the return of genetic results to research participants

“…Studies suggest rates of uptake of clinic appointments/genetic testing following receipt of such letters are variable (Meiser 2005;Lerman et al 1999;Lerman et al 1996;Meijers-Heijboer et al 2000;Wakefield et al 2011;Wakefield et al 2013;Hallowell et al 2013;Keogh et al 2014). In most clinic/research populations, uptake of genetic counselling and testing is consistent at~50 % for germline mutations associated with breast, ovarian and colorectal cancers (Meiser et al 2013;Lerman et al 1996;Lerman et al 1999;Botkin et al 2003). Where public knowledge of cancer predisposition genes is less well known, uptake is lower (Bishop et al 2002;Hayward 2003).…”