Exploring the acceptability of risk-reducing salpingectomy for people at high lifetime risk of ovarian cancer: The patient perspective
Alexandra Lukey1,2, Michael R Law1,3, David Huntsman2,4, Celeste Leigh Pearce5, Fuchsia Howard6, Rafael Meza1,7, Minh Tung Phung5, Gillian E Hanley2,7.
1School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; 2Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada; 3Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada; 4Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada; 5Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, United States; 6School of Nursing, University of British Columbia, Vancouver, BC, Canada; 7BC Cancer Research Institute, Vancouver, BC, Canada
Introduction
With recent evidence that opportunistic salpingectomy, i.e., removal of the fallopian tubes at the time of another pelvic surgery, is effective in preventing high grade serous carcinoma (HGSC), it is imperative to consider the optimal utilization of this procedure. The largest reduction in HGSC mortality and morbidity may occur by targeting salpingectomy to those at increased lifetime risk of ovarian cancer (despite not having a pathogenic variant). In this research, we examined the patient acceptability of using salpingectomy as a stand-alone surgery for those at higher-than-average lifetime risk, known as ‘risk-reducing salpingectomy’(RRS).
Methods
We conducted an online survey in British Columbia of people at risk of ovarian cancer who might benefit from RRS. Participants completed a questionnaire on demographics, risk and protective factors, interest in RRS, concerns of RRS and the lifetime ovarian cancer risk considered actionable. We used descriptive statistics and regression analyses to determine acceptability and related factors.
Results
Of the 211 participants, 43% (n = 91) indicated they would consider RRS at any lifetime risk or any risk above the population average of 1.4%. Twelve participants (5.7%) indicated they would not consider RRS at any risk level. The remaining 51.3% (n = 108) opted for a risk range between 1.5% and >10% as warranting the receipt of RRS. The most common concerns regarding RRS were the risk of surgical complications, 47.9% (n = 125), and the desire not to have surgery unless absolutely necessary 29.1% (n = 76). In the adjusted model, only a higher number of live births was significantly associated with reporting a higher lifetime risk to warrant RRS.
Conclusions
Our sample showed broad interest in RRS as an ovarian cancer prevention strategy. Future research should assess the safety and feasibility of RRS for people with a higher-than-average lifetime risk of ovarian cancer but without pathogenic variants.
Canadian Institutes of Health Research, Canada Graduate Scholarships — Doctoral program. North Family Foundation, Vancouver General Hospital & University of British Columbia Hospital Foundation-Gynecologic Cancer Initiative Clinical Trials Group Accelerating Grants Program.