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

Chandrasekaran, Dhivya; Menon, Usha; Evans, D. Gareth; Crawford, Robin; Sarıdoğan, Ertan; Jacobs, Chris; Tischkowitz, Marc; Brockbank, Elly; Kalsi, JS; Manchanda, Ranjit

doi:10.1007/s10689-015-9823-y

Cited by 16 publications

(18 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…From our qualitative study, we identified the following factors important in the decision for salpingo‐oophorectomy or salpingectomy with delayed oophorectomy: ovarian and breast cancer risks; onset of premature menopause; level of evidence for the efficacy and safety of either strategy; medical history; family history; number of operations . The additional literature search yielded two publications on BRCA1/2 mutation carriers and professionals surveyed about salpingectomy with delayed oophorectomy. Factors reported to influence the decision are consequences of premature menopause, HRT, surgical morbidity, potential ovarian damage and lack of data on level of benefit and cancer risks …”

Section: Resultsmentioning

confidence: 99%

“…The additional literature search yielded two publications on BRCA1/2 mutation carriers and professionals surveyed about salpingectomy with delayed oophorectomy. Factors reported to influence the decision are consequences of premature menopause, HRT, surgical morbidity, potential ovarian damage and lack of data on level of benefit and cancer risks …”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

A patient decision aid for risk‐reducing surgery in premenopausal BRCA1/2 mutation carriers: Development process and pilot testing

Harmsen

Steenbeek

Hoogerbrugge

et al. 2017

Health Expectations

View full text Add to dashboard Cite

Background BRCA1/2 mutation carriers’ choice between risk‐reducing salpingo‐oophorectomy (RRSO) and salpingectomy with delayed oophorectomy is very complex. Aim was to develop a patient decision aid that combines evidence with patient preferences to facilitate decision making.DesignSystematic development of a patient decision aid in an iterative process of prototype development, alpha testing by patients and clinicians and revisions using International Patient Decision Aid Standards (IPDAS) quality criteria. Information was based on the available literature and current guidelines. A multidisciplinary steering group supervised the process.Setting and participantsPre‐menopausal BRCA1/2 mutation carriers choosing between RRSO and salpingectomy with delayed oophorectomy in Family Cancer Clinics in the Netherlands.Main outcome measuresIPDAS quality criteria, relevance, usability, clarity.ResultsThe patient decision aid underwent four rounds of alpha testing and revisions. Finally, two paper decision aids were developed: one for BRCA1 and one for BRCA2. They both contained a general introduction, three chapters and a step‐by‐step plan containing a personal value clarification worksheet. During alpha testing, risk communication and information about premature menopause and hormone therapy were the most revised items. The patient decision aids fulfil 37 of 43 (86%) IPDAS criteria for content and development process.Discussion and conclusionsBoth BRCA1/2 mutation carriers and professionals are willing to use or offer the developed patient decision aids for risk‐reducing surgery. The patient decision aids have been found clear, balanced and comprehensible. Future testing among patients facing the decision should point out its effectiveness in improving decision making.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

A patient decision aid for risk‐reducing surgery in premenopausal BRCA1/2 mutation carriers: Development process and pilot testing

Harmsen

Steenbeek

Hoogerbrugge

et al. 2017

Health Expectations

View full text Add to dashboard Cite

show abstract

“…56 We found approximately 80% support among UK clinicians for such a study. 57 A trial in the UK (PROTEC-TOR study) is about to commence later this year.…”

Section: Risk-reducing Salpingectomymentioning

confidence: 99%

Setting the Threshold for Surgical Prevention in Women at Increased Risk of Ovarian Cancer

Manchanda

Menon

2018

Int J Gynecol Cancer

Self Cite

View full text Add to dashboard Cite

The number of ovarian cancer cases is predicted to rise by 14% in Europe and 55% worldwide over the next 2 decades. The current absence of a screening program, rising drug/treatment costs, and only marginal improvements in survival seen over the past 30 years suggest the need for maximizing primary surgical prevention to reduce the burden of ovarian cancer. Primary surgical prevention through risk-reducing salpingo-oophorectomy (RRSO) is well established as the most effective method for preventing ovarian cancer. In the UK, it has traditionally been offered to high-risk women (>10% lifetime risk of ovarian cancer) who have completed their family. The cost-effectiveness of RRSO in BRCA1/BRCA2 carriers older than 35 years is well established. Recently, RRSO has been shown to be cost-effective in postmenopausal women at lifetime ovarian cancer risks of 5% or greater and in premenopausal women at lifetime risks greater than 4%. The acceptability, uptake, and satisfaction with RRSO at these intermediate-risk levels remain to be established. Prospective outcome data on risk-reducing salpingectomy and delayed-oophorectomy for preventing ovarian cancer is lacking, and hence, this is best offered for primary prevention within the context and safe environment of a clinical trial. An estimated 63% of ovarian cancers occur in women with greater than 4% lifetime risk and 53% in those with 5% or greater lifetime-risk. Risk-reducing salpingo-oophorectomy can be offered for primary surgical prevention to women at intermediate risk levels (4%-5% to 10%). This includes unaffected women who have completed their family and have RAD51C, RAD51D, or BRIP1 gene mutations; first-degree relatives of women with invasive epithelial ovarian cancer; BRCA mutation-negative women from high-risk breast-and-ovarian cancer or ovarian-cancer-only families. In those with BRCA1, RAD51C/RAD51D/MMR mutations and the occasional families with a history of ovarian cancer in their 40s, surgery needs to be considered at younger than 45. In other moderate-risk gene mutation carriers and those with polygenic risk, RRSO needs be considered at 50. There is need for establishment/expansion of well-defined pathways to increase clinical access to RRSO. It is time to lower the risk threshold for RRSO to enable introduction of a targeted primary prevention approach, which could significantly impact the future burden of ovarian cancer.

show abstract

“…Among patients, the main concerns stem from awareness of the seriousness of OC, uncertainty about the risk reduction provided by PSDO, a family history of OC, and personal history of BC . Among caregivers, including gynecologic oncologists and geneticists, the main deterrents are scarcity of data on the level of benefit (83%), increased morbidity from adding a second procedure (79%), loss of BC risk reduction (68%), the need for long‐term follow‐up (61%), and possible failure by some women to complete the interval oophorectomy (66%) .…”

Section: Alternatives To Rrbsomentioning

confidence: 99%

Risk-Reducing Strategies for Ovarian Cancer in BRCA Mutation Carriers: A Balancing Act

Tschernichovsky

Goodman

2017

The Oncologist

View full text Add to dashboard Cite

Objective. The objective of this study was to review the role of bilateral salpingo-oophorectomy in BRCA mutation (mBRCA) carriers and alternative interventions in risk reduction of ovarian cancer (OC). Materials and Methods. A systematic review using PubMed, MEDLINE, EMBASE, and the Cochrane library was conducted to identify studies of different strategies to prevent OC in mBRCA carriers, including bilateral salpingo-oophorectomy, prophylactic salpingectomy with delayed oophorectomy, intensive surveillance, and chemoprevention. Results. Risk-reducing bilateral salpingo-oophorectomy is an effective intervention, but its associated morbidity is substantial and seems to curtail uptake rates among the target population. Although there is much interest and a strong theoretical basis for salpingectomy with delayed oophorectomy, data on its clinical application are scarce with regard to screening, the use of an algorithmic protocol has recently shown favorable albeit indefinite results in average-risk postmenopausal women. Its incorporation into studies focused on high-risk women might help solidify a future role for screening as a bridge to surgery. The use of oral contraceptives for chemoprevention is well supported by epidemiologic studies. However, there is a lack of evidence for advocating any of the other agents proposed for this purpose, including nonsteroidal anti-inflammatory drugs, vitamin D, and retinoids. Conclusion. Further studies are needed before salpingectomy with delayed oophorectomy or intensive surveillance can be offered as acceptable, less morbid alternatives to upfront oophorectomy for mBRCA carriers. The Oncologist 2017;22:450-459 Implications for Practice: Risk-reducing bilateral salpingo-oophorectomy is currently the most effective method for reducing the risk of ovarian cancer in BRCA mutation (mBRCA) carriers. Unfortunately, it is associated with significant short-and long-term morbidity, stemming from reduced circulating estrogen. In recent years, much research has been devoted to evaluating less morbid alternatives, especially multimodal cancer screening and prophylactic salpingectomy with delayed oophorectomy. This review describes the present state of the art, with the aim of informing the counseling provided to mBRCA carriers on this complicated issue and encouraging additional research to facilitate the incorporation of such alternatives into routine practice.

show abstract

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

Abstract: Background

Cited by 16 publications

References 51 publications

A patient decision aid for risk‐reducing surgery in premenopausal BRCA1/2 mutation carriers: Development process and pilot testing

A patient decision aid for risk‐reducing surgery in premenopausal BRCA1/2 mutation carriers: Development process and pilot testing

Setting the Threshold for Surgical Prevention in Women at Increased Risk of Ovarian Cancer

Risk-Reducing Strategies for Ovarian Cancer in BRCA Mutation Carriers: A Balancing Act

Contact Info

Product

Resources

About