Introduction/Background With increasing evidence and acceptability of the central role of the fallopian-tube in the etiopathogeneisis of epithelial ovarian cancer (OC), risk-reducing-early-salpingectomy-and-delayed-oophorectomy (RRESDO) has been proposed as a two-stage surgical alternative to risk reducing salpingo-oophorectomy (RRSO). RRESDO offers some level of risk reduction to women who decline/wish to delay RRSO whilst conserving ovarian function and avoiding detrimental consequences of premature-menopause. However, prospective outcome data for RRESDO are lacking. The aim of this study was to determine RRESDO acceptability and effect of surgical prevention on menopausal sequelae/satisfaction/regret in women at increased OC risk.
Methodology UK Multicentre, cohort, study (IRSCTN:12310993). OC unaffected UK women ≥18years, at increased OC-risk, with/without previous RRSO, ascertained through specialist familial-cancer/genetic-clinics and BRCA support-groups. High-risk women completed a 39-item customised questionnaire developed through literature review, expert clinician and patient support groups’ involvement. Baseline characteristics were described using descriptive statistics. Logistic/linear-regression models analysed impact of variables on RRESDO acceptability and health-outcomes. Main outcomes were RRESDO acceptability, barriers/facilitators, menopausal-sequelae, satisfaction/regret.
Results 346 of 683 participants underwent risk-reducing salpingo-oophorectomy (RRSO) and 337 did not. 69.1% (181/262) premenopausal women who had not undergone RRSO found it acceptable to participate in a research study offering RRESDO. Premenopausal women concerned about sexual-dysfunction were more likely (OR=2.9, 95%CI=1.2–7.7, p=0.025) to find RRESDO acceptable. Women experiencing sexual-dysfunction after premenopausal-RRSO were more likely to find RRESDO acceptable in retrospect (OR=5.3, 95%CI=1.2–27.5, p<0.031). 88.8%(143/161) premenopausal versus 95.2%(80/84) postmenopausal women who underwent RRSO respectively were satisfied with their decision. 9.4%(15/160) premenopausal and 1.2%(1/81) postmenopausal women who underwent RRSO regretted their decision. HRT-uptake in breast-cancer (BC) unaffected premenopausal individuals was 74.1% (80/108). ). HRT-use did not significantly affect satisfaction/regret levels but reduced symptoms of vaginal-dryness (OR=0.4, 95%CI=0.2–0.9, p=0.025).
Conclusion Data show high RRESDO acceptability particularly in women concerned about sexual-dysfunction. Although RRSO satisfaction remains high, regret rates are much higher for premenopausal women than postmenopausal women. HRT use following premenopausal RRSO does not increase satisfaction and reduces vaginal dryness.
Disclosures Funding: Rosetrees Trust.
RM declares research funding from Barts Charity and Eve-Appeal outside this work, honorarium for advisory board membership from Astrazeneca/MSD, and from Israel National Institute for Health Policy Research, support from NHS Innovation Accelerator Fellowship. UM has a financial interest in Abcodia, Ltd., a company for academic and commercial development of biomarkers for screening and risk prediction. DGE declares honoraria for advisory board membership from Astrazeneca. The other authors declare no conflict of interest.
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