Attitudes towards risk‐reducing early salpingectomy with delayed oophorectomy for ovarian cancer prevention: a cohort study

F Gaba, O Blyuss, D Chandrasekaran, M Osman, S Goyal, C Gan, L Izatt, V Tripathi, I Esteban, L McNicol, K Ragupathy, R Crawford, DG Evans, R Legood, U Menon, R Manchanda* (Corresponding Author)

*Corresponding author for this work

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Abstract

Objective To determine risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) acceptability and effect of surgical prevention on menopausal sequelae/satisfaction/regret in women at increased ovarian cancer (OC) risk. Design Multicentre, cohort, questionnaire study (IRSCTN:12310993). Setting United Kingdom (UK). Population UK women without OC ≥18 years, at increased OC risk, with/without previous RRSO, ascertained through specialist familial cancer/genetic clinics and BRCA support groups. Methods Participants completed a 39-item questionnaire. Baseline characteristics were described using descriptive statistics. Logistic/ linear regression models analysed the impact of variables on RRESDO acceptability and health outcomes. Main outcomes RRESDO acceptability, menopausal sequelae, satisfaction/regret. Results In all, 346 of 683 participants underwent risk-reducing salpingo-oophorectomy (RRSO). Of premenopausal women who had not undergone RRSO, 69.1% (181/262) found it acceptable to participate in a research study offering RRESDO. Premenopausal women concerned about sexual dysfunction were more likely to find RRESDO acceptable (odds ratio [OR] = 2.9, 95% CI 1.2–7.7, P = 0.025). Women experiencing sexual dysfunction after premenopausal RRSO were more likely to find RRESDO acceptable in retrospect (OR = 5.3, 95% CI 1.2–27.5, P < 0.031). In all, 88.8% (143/161) premenopausal and 95.2% (80/84) postmenopausal women who underwent RRSO, respectively, were satisfied with their decision, whereas 9.4% (15/160) premenopausal and 1.2% (1/81) postmenopausal women who underwent RRSO regretted their decision. HRT uptake in premenopausal individuals without breast cancer (BC) was 74.1% (80/108). HRT use did not significantly affect satisfaction/regret levels but did reduce symptoms of vaginal dryness (OR = 0.4, 95% CI 0.2–0.9, P = 0.025). Conclusion Data show high RRESDO acceptability, particularly in women concerned about sexual dysfunction. Although RRSO satisfaction remains high, regret rates are much higher for premenopausal women than for postmenopausal women. HRT use following premenopausal RRSO does not increase satisfaction but does reduce vaginal dryness.
Original languageEnglish
Pages (from-to)714-726
Number of pages13
JournalBJOG: An International Journal of Obstetrics & Gynaecology
Volume128
Issue number4
Early online date16 Aug 2020
DOIs
Publication statusPublished - 11 Mar 2021

Bibliographical note

Acknowledgements
The study is supported by researchers at the Barts Cancer Research UK Centre for Excellence, Queen Mary University of London (C16420/A18066). We are particularly grateful to the women who participated in the study. We are grateful to the entire medical, nursing and administrative staff who work on the RRESDO Survey Study. We are grateful to BRCA Umbrella for increasing awareness of our study. We are grateful to Barts Health NHS Trust, University College London Hospitals NHS Foundation Trust, Guy’s and St Thomas’ NHS Foundation Trust, Manchester University NHS Foundation Trust, Cambridge University Hospitals NHS Foundation Trust and NHS Tayside for their support of the study. We are grateful to Nicola Flaum and Robert D. Morgan for their support. DGRE is sup- ported by the Manchester National Institute for Health Research Biomedical Research Centre (IS-BRC-1215- 20007). NF and RDM are supported by Cancer Research UK.

Funding
This work underwent peer-review and was supported by Rosetrees Trust (grant number M779). The funding body had no role in the study design, data collection, analysis, interpretation or writing of the report or decision to sub- mit for publication. The UK PROTECTOR study into early salpingectomy in high-risk women is supported by The Barts Charity (grant MRC0167). The research team was independent of funders.
The funding body had no role in the study design, data collection, analysis, interpretation or writing of the report or decision to submit for publication. The research team was independent of funders.

Keywords

  • Acceptability
  • BRCA
  • ovarian cancer
  • risk-reducing early salpingectomy with delayed oophorectomy

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