Interpretation of ovarian cancer risk and subsequent consideration of risk-reducing salpingo-oophorectomy in Hereditary Breast and Ovarian Cancer and Lynch syndrome
Rebekah J Kukurudz-Gorowski1, Kim Serfas2, Renée El-Gabalawy3,4, Kirk McManus1,5, Mark W Nachtigal1,5,6.
1Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, MB, Canada; 2Shared Health Program of Genetics and Metabolism, Health Sciences Centre, Winnipeg, MB, Canada; 3IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada; 4Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada; 5Paul Albrechtsen Research Institute, CancerCare Manitoba, Winnipeg, MB, Canada; 6Obstetrics, Gynecology, and Reproductive Sciences, University of Manitoba, Winnipeg, MB, Canada
Manitoba Ovarian Cancer Research Program.
Introduction: Hereditary Breast and Ovarian Cancer (HBOC) and Lynch syndrome (LS) are hereditary conditions that increase risk of developing cancer, including epithelial ovarian cancer (EOC). The risk of developing EOC depends on the inherited gene with a pathogenic variant (e.g., BRCA1 or PMS2). Risk-reducing salpingo-oophorectomy (RRSO) is a procedure in which one or both fallopian tubes and ovaries are removed to reduce the risk of EOC. The National Comprehensive Cancer Network’s (NCCN) recommendations for RRSO are based on which pathogenic variant gene is identified. To better serve individuals at risk for EOC, we wished to understand factors that influence decisions to undergo RRSO stratified by their level of risk.
Methods: This study is composed of two arms. Arm 1 is a retrospective chart review to characterize the overall study population stratified according to their level of risk and RRSO status. Arm 2 is a mixed-methods study involving an online survey and interviews to understand how people interpret their risk of EOC and make decisions regarding risk-reduction strategies.
Results: Arm 1 showed the greatest variability for RRSO referral in the low-risk population. Preliminary analysis of Arm 2 indicates that although patients found information on specific cancer risks beneficial, perception of EOC risk was inconsistent, and cancer worry was typically generalized to cancer overall as opposed to specific types. Age, cancer risk reduction, and childbearing are important factors influencing RRSO decision-making. The LS population rarely considered RRSO separate from hysterectomy alone. Cancer risk perception depends on personal and family history, regardless of type.
Conclusion: While patients may be aware of care guidelines for specific genetic findings, the individual context of their situation appears to play a large role in decision-making for RRSO.