Impact of salpingectomy on ovarian cancer risk perception and cancer-related distress in BRCA mutation carriers
Brynne Stewart1,2, Patricia Nguyen1, Michelle Jacobson3, Robert Fruscio4, Kelly A Metcalfe1,5, Steven A Narod1, Joanne Kotsopoulos1,6.
1Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; 2Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; 3Women's College Hospital, Toronto, ON, Canada; 4Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; 5Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada; 6Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
Introduction: Bilateral salpingo-oophorectomy (BSO) is standard of care for ovarian cancer prevention in BRCA mutation carriers and is associated with better overall survival. Interest in salpingectomy with delayed oophorectomy is increasing, but the efficacy of this two-step approach is not known. Cancer risk perception following salpingectomy has implications for psychosocial functioning and preventive care decision-making for high-risk women.
Objectives: To evaluate ovarian cancer risk perception and cancer-related distress among BRCA mutation carriers who elected salpingectomy relative to those who had a BSO or no surgery.
Study Methods: BRCA mutation carriers with no personal history of ovarian cancer were invited to complete a baseline questionnaire, and a follow-up questionnaire every two years thereafter. The questionnaire collects demographic information, surgical history, perceived lifetime ovarian cancer risk, and ovarian cancer risk-related distress as indicated by the Impact of Event Scale (IES). Respondents were grouped according to surgical history at baseline: 1) no surgery, 2) bilateral salpingectomy, or 3) BSO. ANOVA was used to compare perceived risk and IES scores between groups.
Results: To date, 415 women have completed the baseline questionnaire (mean age 44 years, range 21-79); 152 (36.6%) had no surgery, 55 (13.3%) salpingectomy, and 208 (50.1%) BSO. Perceived risk varied significantly by surgical history, and was 57.6%, 37.8%, and 16.4% in the three groups, respectively (p <0.001). IES scores were significantly higher in the no surgery group (27.4) compared with the salpingectomy (13.2) or BSO (13.4) groups (p < 0.001).
Conclusion: BRCA mutation carriers who elected salpingectomy had low ovarian cancer-related distress relative to their perceived risk. Consideration of this finding will facilitate personalized patient counselling, with emphasis on the known role of oophorectomy for cancer prevention and overall survival.