Risk reducing salpingectomy and delayed oophorectomy in high risk women: views of cancer geneticists, genetic counsellors and gynaecological oncologists in the UK

Abstract

Risk-reducing-salpingectomy and Delayed-Oophorectomy (RRSDO) is being proposed as a two-staged approach in place of RRSO to reduce the risks associated with premature menopause in high-risk women. We report on the acceptability/attitude of UK health professionals towards RRSDO. An anonymised web-based survey was sent to UK Cancer Genetics Group (CGG) and British Gynaecological Cancer Society (BGCS) members to assess attitudes towards RRSDO. Baseline characteristics were described using descriptive statistics. A Chi square test was used to compare categorical, Kendal-tau-b test for ordinal and Mann-Whitney test for continuous variables between two groups. 173/708 (24.4%) of invitees responded. 71% respondents (CGG = 57%/BGCS = 83%, p = 0.005) agreed with the tubal hypothesis for OC, 55% (CGG = 42%/BGCS = 66%, p = 0.003) had heard of RRSDO and 48% (CGG = 46%/BGCS = 50%) felt evidence was not currently strong enough for introduction into clinical practice. However, 60% respondents' (CGG = 48%/BGCS = 71%, p = 0.009) favoured offering RRSDO to high-risk women declining RRSO, 77% only supported RRSDO within a clinical trial (CGG = 78%/BGCS = 76%) and 81% (CGG = 76%/BGCS = 86%) advocated a UK-wide registry. Vasomotor symptoms (72%), impact on sexual function (63%), osteoporosis (59%), hormonal-therapy (55%) and subfertility (48%) related to premature menopause influenced their choice of RRSDO. Potential barriers to offering the two-stage procedure included lack of data on precise level of benefit (83%), increased surgical morbidity (79%), loss of breast cancer risk reduction associated with oophorectomy (68%), need for long-term follow-up (61%) and a proportion not undergoing DO (66%). There were variations in perception between BGCS/CGG members which are probably attributable to differences in clinical focus/expertise between these two groups. Despite concerns, there is reasonable support amongst UK clinicians to offering RRSDO to premenopausal high-risk women wishing to avoid RRSO, within a prospective clinical trial.

Keywords: BRCA; Delayed oophorectomy; High-risk; Ovarian cancer; RRSDO; Risk reducing salpingectomy.