Factors associated with deciding between risk-reducing salpingo-oophorectomy and ovarian cancer screening among high-risk women enrolled in GOG-0199: An NRG Oncology/Gynecologic Oncology Group study

Phuong L. Mai, Marion Piedmonte, Paul K. Han, Richard P. Moser, Joan L. Walker, Gustavo Rodriguez, John Boggess, Thomas J. Rutherford, Oliver Zivanovic, David E. Cohn, J. Tate Thigpen, Robert M. Wenham, Michael L. Friedlander, Chad A. Hamilton, Jamie Bakkum-Gamez, Alexander B. Olawaiye, Martee L. Hensley, Mark H. Greene, Helen Q. Huang, Lari Wenzel

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

Objectives Women at increased genetic risk of ovarian cancer (OC) are recommended to have risk-reducing salpingo-oophorectomy (RRSO) after completion of reproductive planning. Effective screening has not been established, and novel screening modalities are being evaluated. Methods Participants chose either RRSO or a novel OC screening regimen (OCS) as their risk management option, and provided demographic and other data on BRCA mutation status, cancer worry, perceived intervention risks/benefits, perceived cancer risk, and quality-of-life at enrollment. We performed univariate and multivariate analyses to evaluate factors influencing decision between RRSO and OCS. Results Of 2287 participants enrolled, 904 (40%) chose RRSO and 1383 (60%) chose OCS. Compared with participants choosing OCS, participants choosing RRSO were older (p < 0.0001), more likely to carry deleterious BRCA1/2 mutations (p < 0.0001), perceive RRSO as effective, be more concerned about surgical harms and OCS limitations, and report higher perceived OC risk and OC-related worry. OCS participants were more likely to perceive screening as effective, be more concerned about menopausal symptoms, infertility, and loss of femininity, and report better overall quality-of-life. Twenty-four percent of participants believed they would definitely develop OC, and half estimated their lifetime OC risk as > 50%, both higher than objective risk estimates. Conclusions Cancer worry, BRCA1/2 mutation status, and perceived intervention-related risks and benefits were associated with choosing between RRSO and OCS. Efforts to promote individualized, evidence-based, shared medical decision-making among high-risk women facing management choices should focus on conveying accurate OC risk estimates, clarifying the current understanding of intervention-related benefits and limitations, and addressing OC worry.

Original languageEnglish (US)
Pages (from-to)122-129
Number of pages8
JournalGynecologic oncology
Volume145
Issue number1
DOIs
StatePublished - Apr 1 2017

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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