Psychological impact of prophylactic oophorectomy in women at increased risk of developing ovarian cancer: a prospective study

Surgical advances in the treatment of ovarian cancer

Surgical intervention remains a key component in the diagnosis and management of epithelial ovarian carcinomas. Although the parameters defining "optimal" tumor cytoreduction continue to evolve, data validate the concept of complete operative tumor resection to no visible residual disease in all stages of ovarian cancer to prolong disease-free and overall survival. In select patients, recurrent disease also may be managed with surgical cytoreduction. At the other end of the spectrum, prophylactic bilateral salpingo-oophorectomy has been shown conclusively to reduce the risk of ovarian cancer in women at high risk. Although BRCA1-associated and BRCA2-associated gynecologic cancer syndromes do not seem to include uterine malignancies, the role of hysterectomy to remove the fallopian tube completely is controversial. Finally, new data support the concept of conservative, fertility-sparing surgery in a select group of women with early-stage disease. Although laparoscopy may be feasible in staging women with disease apparently limited to an ovary, further studies are necessary before it can be considered routinely as an alternative to standard laparotomy.

Quality of life in women at risk for ovarian cancer who have undergone risk-reducing oophorectomy

OBJECTIVES

Women at risk for ovarian cancer may consider risk-reducing salpingo-oophorectomy (RRSO), and desire information regarding the health consequences of the procedure. We studied women who had undergone RRSO to assess quality of life after the procedure.

METHODS

Women (n = 59) undergoing RRSO between 1 January 1997 and 31 July 2000 completed a questionnaire composed of the Symptom Checklist (SCL), the Medical Outcomes Study SF-36 Health Survey, the Center for Epidemiological Studies Depression Scale, the Impact of Events Scale, and the Sexual Functioning Questionnaire-Female.

RESULTS

At a mean of 23.8 months after RRSO, overall quality of life was similar to that reported for the general population and for breast cancer survivors. Estrogen deprivation symptoms, particularly vaginal dryness (35.2%) and dyspareunia (27.7%), were commonly bothersome. Genital symptoms resulting in sexual dysfunction were the most significant predictors of satisfaction with surgery. The prevalence of depression (20.4%) was similar to that of the general population, but a significant proportion of the group (20.7%) continued to report significant ovarian cancer-specific worries despite surgery.

CONCLUSION

Vaginal symptoms are bothersome to women who have undergone RRSO, but overall health and psychological outcomes are not impaired. Although coital symptoms may not be a direct consequence of RRSO, they are the most important predictors of satisfaction. A proportion of women continue to report worries about ovarian cancer after surgery, and these women are at risk for psychological distress.