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2022-RA-1270-ESGO Quality of Life after risk-reducing surgery for breast and ovarian cancer prevention: a systematic review and meta-analysis
  1. Xia Wei1,
  2. Samuel Oxley2,
  3. Michail Sideris2,
  4. Ashwin Kalra2,
  5. Rosa Legood1 and
  6. Ranjit Manchanda2
  1. 1London School of Hygeine and Tropical Medicine, London, UK
  2. 2Wolfson Institute of Population Health, Queen Mary University of London, London, UK


Introduction/Background RRS is the most-effective prevention for breast-cancer (BC) and ovarian-cancer (OC) in women with increased-risk. We aimed to assess the quality-of-life (QoL) impact of risk-reducing surgery (RRS) including risk-reducing-mastectomy (RRM), risk-reducing-salpingo-oophorectomy (RRSO) and risk-reducing early-salpingectomy and delayed-oophorectomy (RRESDO) through a systematic review and meta-analysis.

Methodology We searched major databases until December 2021 following a prospective protocol (PROSPERO-CRD42022319782). Qualitative-synthesis was performed to identify the impact of RRS on various QoL outcomes. Fixed-effects meta-analysis was performed to obtain pooled estimates of QoL outcomes.

Results Thirty-one studies were included (N=4151 post-RRS vs. N=3905 controls). 12/12 studies post-RRM (N=944) reported unchanged general-health QoL, and 10/16 (N=1911) post-RRSO reported unchanged/improved general-health QoL despite short-term deficits (N=578). 13/16 studies (N=1602) showed affected sexual-function post-RRSO. Meta-analysis showed a reduction (-1.21[-1.53,-0.89]; N=3070) in sexual-pleasure and an increase (1.12[0.93,1.31]; N=1400) in sexual-discomfort using the Sexual-Activity-Questionnaire. HRT in pre-menopausal RRSO was associated (on meta-analysis) with an increase (1.16 [0.17, 2.15]; N=291) in sexual-pleasure and a decrease (-1.20 [-1.75, -0.65]; N=157) in sexual-discomfort. 4/10 studies post-RRM (N=236) showed impacted sexual-function, while 6/10 (N=572) showed stable sexual-function. 5/10 studies post-RRM (N=514) reported no body-image problems, whereas 5/10 (N=344) showed otherwise. 12/13 studies (N=1871) reported increased menopause symptoms post-RRSO with a reduction (-1.96 [-2.81, -1.10]; N=1745) in Functional-Assessment-of-Cancer-Therapy-Endocrine Subscale on meta-analysis. 5/5 studies (N=365) post-RRM and 8/10 (N=1223) post-RRSO reported unchanged/decreased cancer-related-distress. RRESDO (2 studies, N=413) resulted in better sexual-function and menopause-specific QoL.

Conclusion RRM/RRSO reduced cancer-related distress with unaffected general-health QoL. Women/clinicians should be aware of the negative impact of sexual dysfunction and menopause related symptoms from RRSO, along-with potential detrimental impact of RRM on body-image. Early salpingectomy does not appear to increase sexual dysfunction or impact menopause symptoms and RRESDO may be a promising alternative to mitigate QoL-related risks.

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