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Perceptions of risk and reward in BRCA1 and BRCA2 mutation carriers choosing salpingectomy for ovarian cancer prevention

Abstract

Salpingectomy with interval oophorectomy has gained traction as an ovarian cancer prevention strategy, but is not currently recommended for high risk women. Nevertheless, some choose this approach. We aimed to understand risk perception and plans for oophorectomy in BRCA1 and BRCA2 (BRCA) mutation carriers choosing salpingectomy for ovarian cancer prevention. This was a longitudinal survey study of BRCA mutation carriers who underwent bilateral salpingectomy to reduce ovarian cancer risk. An initial written questionnaire and telephone interview was followed by annual phone interviews. 22 women with BRCA mutations were enrolled. Median follow-up was three years. The median age at salpingectomy was 39.5 years (range 27–49). Perceived lifetime ovarian cancer risk decreased by half after salpingectomy (median risk reduction 25%, range 0–40%). At final follow-up, five (22.7%) had undergone oophorectomy and five women (22.7%) were not planning to undergo completion oophorectomy. BRCA mutation carriers who had salpingectomy after the recommended age of prophylactic surgery (vs. before the recommended age) were less likely to plan for future oophorectomy (28.6% vs. 66.7%, p = 0.037). All women were satisfied with their decision to undergo salpingectomy with eighteen (81.8%) expressing decreased cancer-related worry. There were no diagnoses of ovarian cancer during our study period. In conclusion, most BRCA mutation carriers undergoing risk-reducing salpingectomy are satisfied with their decision and have lower risk perception after salpingectomy, though some older mutation carriers did not plan on future oophorectomy. Salpingectomy with delayed oophorectomy in BRCA mutation carriers remains investigational and should preferably be performed within a clinical trial to prevent introduction of an innovation before safety has been proven.

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Acknowledgements

We thank Dr. Sue Friedman and FORCE (Facing our Risk of Cancer Empowered, https://www.facingourrisk.org/index.php) for inspiration, support and recruitment for this study.

Funding

The Wendy Feuer Fund for the Prevention and Treatment of Ovarian Cancer.

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TSG: Data curation, methodology, formal analysis, writing—original draft. LES: Data curation, methodology, writing—original draft. BMN: Conceptualization, review and editing. DJB: Review and editing. VY: Data curation. KJA: Data curation. KPP: Review and editing. EMS: Conceptualization, supervision, writing—review and editing.

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Correspondence to Talayeh S. Ghezelayagh.

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Ghezelayagh, T.S., Stewart, L.E., Norquist, B.M. et al. Perceptions of risk and reward in BRCA1 and BRCA2 mutation carriers choosing salpingectomy for ovarian cancer prevention. Familial Cancer 19, 143–151 (2020). https://doi.org/10.1007/s10689-020-00166-5

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Keywords

  • Salpingectomy
  • BRCA1
  • BRCA2
  • Ovarian cancer prevention
  • Hereditary ovarian cancer
  • Delayed oophorectomy