A study of 24 women from the UK PROTECTOR test has revealed that their concerns about the risk of cancer and menopause affect their choice of surgery as a treatment for ovarian cancer, according to findings published online today in Journal of Medical Genetics.
Some women, all at high risk from cancer due to the presence of the BRCA gene, they preferred to manage this risk through a 2-step surgical treatment course, stage 1 having salpingectomy (fallopian tube removal) and stage 2 oophorectomy (ovary removal), rather than 1 more extensive surgery . For this study, the first was classified as early-salpingectomy with delayed oophorectomy (RRESDO) and the second, salpingo-oophorectomy (RRSO) that reduces risk.
Concerns about induced menopause and its adverse effects affected their protective choice, the authors noted in a statement announcing their findings. Those who are more concerned about their cancer risk would opt for the broader approach, they said.
“Routine surgery, removing both the tubes and the appendages, causes menopause in women who have not yet reached this stage of life,” said the authors from Queen Mary University in London. “The other proposed two-step protocol is to delay the induced menopause by removing the ovaries, thus avoiding the side effects of menopause. ”
The lifetime risk of ovarian cancer ranges from 17% to 44% in women with BRCA1 no BRCA2. Of the women in this study, aged between 34 and 46 years, 91.7% were Caucasian, 16.7% had never given birth, 16.7% had a history of breast cancer, 37.5% had undergone risk reduction mastectomy ( RRM). , It was 58.3% BRCA1, with 41.7% BRCA2.
Investigators conducted 1: 1 interviews with all women, obtained responses through open-ended questions, and revealed 7 interrelated topics of decision-making when all responses were recorded:
- Illness
- Menopause
- Cancer risk reduction / surgical options
- Surgical complications
- A series of ovarian and breast prophylactic surgeries
- Decision support
- Satisfaction with treatment options
The authors found that taking pregnancy out of the picture helped to facilitate women’s choice. Of the 18 women in the study who eventually opted for surgery, 16 and 2 had children who did not want children.
Their analyzes found the following:
- Women with a history of breast cancer who BRCA carriers chose RRESDO despite awareness of the benefits of premenopausal oophorectomy
- Maintaining quality of life was a concern BRCA carriers, history of breast cancer notwithstanding
- Proximity to natural menopause and potential health concerns emerged as potential barriers to RRESDO
- Without seeking hormone replacement therapy (HRT), concerns about the appropriate treatment of menopause symptoms, positive experiences with prior surgery, reduced anxiety, and delayed oophorectomy delays affected her. decided to go through RRESDO
- Women receiving care in high-risk familial cancer, or specialized clinics, reported greater satisfaction of care against women cared for in nonspecialist clinics
The authors explain this latest discovery of the growing amount of multidisciplinary support needed by high-risk women and which those in nonspecific clinics say is lacking. because of “poorly developed care pathways,” such as those for HRT counseling. This includes care from geneticists, gynecologists, and menopause and fertility specialists, among others, including communicating genetic test results with family members.
“There are a number of contextual factors (medical, physical, psychological, social) that influence the timing of risk reduction clinics. RRESDO offers women who delay / delay premenopausal oophorectomy, especially those who are concerned about menopausal effects, a level of reduced risk of ovarian cancer while avoiding early menopause, ”co- the authors closed. “Care for high-risk women should be centralized to centers with family gynecological cancer risk management services to provide a comprehensive and more comprehensive multidisciplinary approach.”
They express confidence in their decisions, as a result of the in-depth interview approach of their study, independent data analysis, and the inclusion of patients from a variety of settings. However, they are also wary of their prevalence as only 2 of their study patients were non-Caucasian and some had already undergone RRM, which may have been biased. introduce a recall.
Information
Gaba F, Goyal S, Signals D, et al. Reduce surgical findings in premenopausal BRCA carriers considering early salpingectomy or salpingo-oophorectomy: a qualitative study. J Med Genet. Published online February 10, 2021. doi: 10.1136 / jmedgenet-2020-107501