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Oxley SG, Wei X, Sideris M, Blyuss O, Kalra A, Sia JJY, Ganesan S, Fierheller CT, Sun L, Sadique Z, Jin H, Manchanda R, Legood R. Utility Scores for Risk-Reducing Mastectomy and Risk-Reducing Salpingo-Oophorectomy: Mapping to EQ-5D. Cancers (Basel) 2024; 16:1358. [PMID: 38611036 PMCID: PMC11010846 DOI: 10.3390/cancers16071358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Risk-reducing mastectomy (RRM) and risk-reducing salpingo-oophorectomy (RRSO) are the most effective breast and ovarian cancer preventive interventions. EQ-5D is the recommended tool to assess the quality of life and determine health-related utility scores (HRUSs), yet there are no published EQ-5D HRUSs after these procedures. These are essential for clinicians counselling patients and for health-economic evaluations. METHODS We used aggregate data from our published systematic review and converted SF-36/SF-12 summary scores to EQ-5D HRUSs using a published mapping algorithm. Study control arm or age-matched country-specific reference values provided comparison. Random-effects meta-analysis provided adjusted disutilities and utility scores. Subgroup analyses included long-term vs. short-term follow-up. RESULTS Four studies (209 patients) reported RRM outcomes using SF-36, and five studies (742 patients) reported RRSO outcomes using SF-12/SF-36. RRM is associated with a long-term (>2 years) disutility of -0.08 (95% CI -0.11, -0.04) (I2 31.4%) and a utility of 0.92 (95% CI 0.88, 0.95) (I2 31.4%). RRSO is associated with a long-term (>1 year) disutility of -0.03 (95% CI -0.05, 0.00) (I2 17.2%) and a utility of 0.97 (95% CI 0.94, 0.99) (I2 34.0%). CONCLUSIONS We present the first HRUSs sourced from patients following RRM and RRSO. There is a need for high-quality prospective studies to characterise quality of life at different timepoints.
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Affiliation(s)
- Samuel G. Oxley
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Xia Wei
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (L.S.); (Z.S.)
| | - Michail Sideris
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Oleg Blyuss
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child´s Health, Sechenov First Moscow State Medical University, Sechenov University, Moscow 119991, Russia
| | - Ashwin Kalra
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Jacqueline J. Y. Sia
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Subhasheenee Ganesan
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
| | - Caitlin T. Fierheller
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
| | - Li Sun
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (L.S.); (Z.S.)
| | - Zia Sadique
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (L.S.); (Z.S.)
| | - Haomiao Jin
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7YH, UK;
| | - Ranjit Manchanda
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London E1 1BB, UK
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (L.S.); (Z.S.)
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials & Methodology, Faculty of Population Health Sciences, University College London, London WC1V 6LJ, UK
| | - Rosa Legood
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (S.G.O.); (X.W.); (M.S.); (O.B.); (A.K.); (J.J.Y.S.); (S.G.); (C.T.F.)
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK; (L.S.); (Z.S.)
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Meshkani Z, Moradi N, Aboutorabi A, Farabi H, Moini N. A cost-benefit analysis of genetic screening test for breast cancer in Iran. BMC Cancer 2024; 24:279. [PMID: 38429685 PMCID: PMC10905849 DOI: 10.1186/s12885-024-12003-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/14/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the implementation of the population- and family history (FH) -based screening for BReast CAncer (BRCA) in Iran, a country where less than 10% of breast cancer cases are attributable to a gene mutation. METHODS This was an economic evaluation study. The Benefit-Cost Ratio (BCR) for genetic screening test strategies in Iranian women older than 30 was calculated. To this end, the monetary value of the test was estimated using the willingness-to-pay (WTP) approach using the contingent valuation method (CVM) by payment card. From a healthcare perspective, direct medical and non-medical costs were considered and a decision model for the strategies was developed to simulate the costs. A one-way sensitivity analysis assessed the robustness of the analysis. The data were analyzed using Excel 2010. RESULTS 660 women were included for estimating WTP and 2,176,919 women were considered in the costing model. The cost per genetic screening test for population- and FH-based strategies was $167 and $8, respectively. The monetary value of a genetic screening test was $20 and it was $27 for women with a family history or gene mutation in breast cancer. The BCR for population-based and FH-based screening strategies was 0.12 and 3.37, respectively. Sensitivity analyses confirmed the robustness of the results. CONCLUSIONS This study recommends the implementation of a FH-based strategy instead of a population-based genetic screening strategy in Iran, although a cascade genetic screening test strategy should be evaluated in future studies.
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Affiliation(s)
- Zahra Meshkani
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
- Health Management and Economics Research Center, Iran University of Medical Sciences, 13833-19967, Tehran, Iran.
| | - Najmeh Moradi
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ali Aboutorabi
- Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hiro Farabi
- Barts and The London Pragmatic Clinical Trial Unit, Centre for Evaluation and Methods, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Nazi Moini
- Breast Cancer Research Centre, Motamed Cancer Institute, ACECR, Tehran, Iran
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Zilski N, Speiser D, Bartley J, Roehle R, Blohmer JU, Keilholz U, Goerling U. Quality of life after risk-reducing salpingo-oophorectomy in women with a pathogenic BRCA variant. J Sex Med 2023; 21:33-39. [PMID: 37973412 DOI: 10.1093/jsxmed/qdad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/27/2023] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Risk-reducing salpingo-oophorectomy (RRSO) is recommended to women with a pathogenic BRCA variant, but as a main side effect, RRSO could lead to an early onset of menopause. AIM To evaluate the impact of RRSO and preoperative menopausal status on menopausal symptoms, sexual functioning, and quality of life (QOL). METHODS The study was conducted between November 2019 and April 2020. Women were included who tested positive for a pathogenic BRCA1/2 variant between 2015 and 2018. Depression levels, QOL, and global health status were measured and compared with those of women who opted against RRSO. Furthermore, women who underwent RRSO treatment were asked to report menopausal complaints that they experienced at 1 month postsurgery and any current complaints. OUTCOMES RRSO had no significant impact on QOL, but women who were premenopausal at the time of surgery reported more sexual complaints than postmenopausal women. RESULTS In total, 134 carriers of a BRCA mutation were included: 90 (67%) underwent RRSO and 44 (33%) did not. At the time of the survey, neither the control nor experimental group experienced significant changes in QOL (b = -0.18, P = .59). Women who underwent RRSO reported a significantly lower global health status (b = -0.66, P = .05). Women who were premenopausal at the time of surgery were bothered more by sexual symptoms (b = 0.91, P = .19) but experienced fewer vasomotor complaints (b = -1.09, P = .13) than women who were postmenopausal at the time of RRSO. CLINICAL IMPLICATIONS The decrease of sexual functioning after RRSO should be an integral part of preoperative counseling because it is important for BRCA carriers, especially for premenopausal women. STRENGTHS AND LIMITATIONS Some strengths of the present study were the long follow-up, a high response rate, and the existence of a control group, whereas defining menopausal status by last menstrual bleeding and self-report of data (eg, breast cancer history) increased the risk of errors. CONCLUSION Our study indicated that women who underwent RRSO experienced no difference in QOL when compared with women without RRSO and that patients with premenopausal status seemed to be at higher risk to experience sexual complaints after surgery.
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Affiliation(s)
- Nicole Zilski
- Hereditary Breast and Ovarian Cancer Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Department of Gynecology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Dorothee Speiser
- Hereditary Breast and Ovarian Cancer Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Department of Gynecology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Julia Bartley
- Department of Gynecology, Universitätsklinikum Magdeburg, 39108 Magdeburg, Germany
- TFP Fertility Berlin, 10117 Berlin, Germany
| | - Robert Roehle
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Clinical Study Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
- Berlin Institute of Health, 10178, Berlin, Germany
| | - Jens-Uwe Blohmer
- Department of Gynecology, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Ulrich Keilholz
- Comprehensive Cancer Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Ute Goerling
- Comprehensive Cancer Center, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany
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Wei X, Oxley S, Sideris M, Kalra A, Brentnall A, Sun L, Yang L, Legood R, Manchanda R. Quality of life after risk-reducing surgery for breast and ovarian cancer prevention: a systematic review and meta-analysis. Am J Obstet Gynecol 2023; 229:388-409.e4. [PMID: 37059410 DOI: 10.1016/j.ajog.2023.03.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE This study aimed to assess the impact of risk-reducing surgery for breast cancer and ovarian cancer prevention on quality of life. We considered risk-reducing mastectomy, risk-reducing salpingo-oophorectomy, and risk-reducing early salpingectomy and delayed oophorectomy. DATA SOURCES We followed a prospective protocol (International Prospective Register of Systematic Reviews: CRD42022319782) and searched MEDLINE, Embase, PubMed, and Cochrane Library from inception to February 2023. STUDY ELIGIBILITY CRITERIA We followed a PICOS (population, intervention, comparison, outcome, and study design) framework. The population included women at increased risk of breast cancer or ovarian cancer. We focused on studies reporting quality of life outcomes (health-related quality of life, sexual function, menopause symptoms, body image, cancer-related distress or worry, anxiety, or depression) after risk-reducing surgery, including risk-reducing mastectomy for breast cancer and risk-reducing salpingo-oophorectomy or risk-reducing early salpingectomy and delayed oophorectomy for ovarian cancer. METHODS We used the Methodological Index for Non-Randomized Studies (MINORS) for study appraisal. Qualitative synthesis and fixed-effects meta-analysis were performed. RESULTS A total of 34 studies were included (risk-reducing mastectomy: 16 studies; risk-reducing salpingo-oophorectomy: 19 studies; risk-reducing early salpingectomy and delayed oophorectomy: 2 studies). Health-related quality of life was unchanged or improved in 13 of 15 studies after risk-reducing mastectomy (N=986) and 10 of 16 studies after risk-reducing salpingo-oophorectomy (N=1617), despite short-term deficits (N=96 after risk-reducing mastectomy and N=459 after risk-reducing salpingo-oophorectomy). Sexual function (using the Sexual Activity Questionnaire) was affected in 13 of 16 studies (N=1400) after risk-reducing salpingo-oophorectomy in terms of decreased sexual pleasure (-1.21 [-1.53 to -0.89]; N=3070) and increased sexual discomfort (1.12 [0.93-1.31]; N=1400). Hormone replacement therapy after premenopausal risk-reducing salpingo-oophorectomy was associated with an increase (1.16 [0.17-2.15]; N=291) in sexual pleasure and a decrease (-1.20 [-1.75 to -0.65]; N=157) in sexual discomfort. Sexual function was affected in 4 of 13 studies (N=147) after risk-reducing mastectomy, but stable in 9 of 13 studies (N=799). Body image was unaffected in 7 of 13 studies (N=605) after risk-reducing mastectomy, whereas 6 of 13 studies (N=391) reported worsening. Increased menopause symptoms were reported in 12 of 13 studies (N=1759) after risk-reducing salpingo-oophorectomy with a reduction (-1.96 [-2.81 to -1.10]; N=1745) in the Functional Assessment of Cancer Therapy - Endocrine Symptoms. Cancer-related distress was unchanged or decreased in 5 of 5 studies after risk-reducing mastectomy (N=365) and 8 of 10 studies after risk-reducing salpingo-oophorectomy (N=1223). Risk-reducing early salpingectomy and delayed oophorectomy (2 studies, N=413) led to better sexual function and menopause-specific quality of life. CONCLUSION Risk-reducing surgery may be associated with quality of life outcomes. Risk-reducing mastectomy and risk-reducing salpingo-oophorectomy reduce cancer-related distress, and do not affect health-related quality of life. Women and clinicians should be aware of body image problems after risk-reducing mastectomy, and of sexual dysfunction and menopause symptoms after risk-reducing salpingo-oophorectomy. Risk-reducing early salpingectomy and delayed oophorectomy may be a promising alternative to mitigate quality of life-related risks of risk-reducing salpingo-oophorectomy.
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Affiliation(s)
- Xia Wei
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom; Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - Samuel Oxley
- Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London, London, United Kingdom; Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom
| | - Michail Sideris
- Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London, London, United Kingdom; Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom
| | - Ashwin Kalra
- Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London, London, United Kingdom; Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom
| | - Adam Brentnall
- Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - Li Sun
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom; Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London, London, United Kingdom
| | - Li Yang
- School of Public Health, Peking University, Beijing, China
| | - Rosa Legood
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ranjit Manchanda
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom; Wolfson Institute of Population Health, Cancer Research UK Barts Centre, Queen Mary University of London, London, United Kingdom; Department of Gynaecological Oncology, Barts Health NHS Trust, Royal London Hospital, London, United Kingdom; Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, Faculty of Population Health Sciences, University College London, London, United Kingdom; Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.
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Mohr-Sasson A, Dadon T, Perri T, Rosenblat O, Friedman E, Korach J. Prophylactic salpingectomy with delayed oophorectomy as a two-staged alternative for primary prevention of ovarian cancer in BRCA1/2 mutation carriers: women's point of view. Menopause 2023; 30:476-479. [PMID: 36917763 DOI: 10.1097/gme.0000000000002168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE This study aimed to determine BRCA -mutation carrier women's interest and acceptability of participating in a study examining prophylactic salpingectomy with delayed oophorectomy (PSDO) as an alternative to the current recommendation for bilateral salpingo-oophorectomy for risk reduction. METHODS This is a cross-sectional questionnaire-based study. All women visiting the high-risk clinics for hereditary breast and ovarian cancer in a single tertiary medical center were asked to complete a questionnaire concerning the two-stage approach from October 2018 to December 2019. Before completing the questionnaire, detailed explanation was given by a senior physician regarding the procedure, related background, possible risks, and benefits. RESULTS The study population included 293 women, of whom 183 (62.4%) were BRCA1 mutation carriers, 97 (33.1%) were BRCA2 mutation carriers, and 13 (4.4%) had unknown familial mutation. Risk-reducing surgery was completed in 160 (55.17%) of the women. First-degree and second-degree family history was reported in 166 (57.24%) and 52 (17.9%) of the women, respectively. Among women surveyed, more than half of the women (n = 66 [51%]) who had yet to undergo risk-reducing surgery reported interest in having PSDO. Similarly, among those who had already received prophylactic surgery, 64 (40%) also considered PSDO to be an acceptable alternative. Multivariate logistic regression analysis found family history of related malignancies to be the only independent factor associated with reduced interest in a study of PSDO (odds ratio, 0.15 [95% confidence interval, 0.29-0.77]; P = 0.02). CONCLUSIONS Overall, BRCA -mutation carrier women indicated interest in PSDO risk-reducing surgery, taking into consideration the potential additional risk. These findings suggest that a clinical study exploring the equivalence of PSDO as alternative treatment is feasible.
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Affiliation(s)
| | - Tal Dadon
- From the Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashome, Ramat Gan, Israel
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Isselhard A, Lautz Z, Rhiem K, Stock S. Assessing Psychological Morbidity in Cancer-Unaffected BRCA1/2 Pathogenic Variant Carriers: A Systematic Review. Curr Oncol 2023; 30:3590-3608. [PMID: 37185387 PMCID: PMC10136916 DOI: 10.3390/curroncol30040274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
Female BRCA1/2 pathogenic variant carriers have an increased lifetime risk for breast and ovarian cancer. Cancer-unaffected women who are newly diagnosed with this pathogenic variant may experience psychological distress because of imminent health threat. No comprehensible review on psychological morbidity in cancer-unaffected BRCA1/2 pathogenic variant carriers is currently available. This review aims to give an overview about all available the studies in which psychological outcomes have been assessed in cancer-unaffected BRCA1/2 pathogenic variant carriers, whether as a primary outcome or secondary measurement. A systematic search across four databases (Web of Science, PubMed, ScienceDirect, and EBSCO) was conducted. Studies had to report on cancer-unaffected pathogenic variant carriers (exclusively or separately) and use a validated measure of psychological morbidity to be eligible. Measures were only included if they were used in at least three studies. The final review consisted of 45 studies from 13 countries. Distress measures, including anxiety and cancer worry, were most often assessed. Most studies found a peak of distress immediately after genetic test result disclosure, with a subsequent decline over the following months. Only some studies found elevated distress in carriers compared to non-carriers in longer follow-ups. Depression was frequently investigated but largely not found to be of clinical significance. Quality of life seemed to be largely unaffected by a positive genetic test result, although there was some evidence that younger women, especially, were less satisfied with their role functioning in life. Body image has been infrequently assessed so far, but the evidence suggested that there may be a decrease in body image after genetic test result disclosure that may decrease further for women who opt for a prophylactic mastectomy. Across all the outcomes, various versions of instruments were used, often limiting the comparability among the studies. Hence, future research should consider using frequently used instruments, as outlined by this review. Finally, while many studies included cancer-unaffected carriers, they were often not reported on separately, which made it difficult to draw specific conclusions about this population.
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Alves-Nogueira AC, Melo D, Carona C, Figueiredo-Dias M. The Psychosocial Impact of the Decision to Undergo Risk-Reducing Salpingo-Oophorectomy Surgery in BRCA Mutation Carriers and the Role of Physician-Patient Communication. Curr Oncol 2023; 30:2429-2440. [PMID: 36826146 PMCID: PMC9955232 DOI: 10.3390/curroncol30020185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
Risk-reducing bilateral salpingo-oophorectomy (RRSO) is an effective prophylactic surgery provided to premenopausal women carrying BRCA1 or BRCA2 mutations and presenting an increased risk of developing breast or ovarian cancer. This procedure is related to physiological, sexual, and psychosocial distress, which altogether increase uncertainty and complexity in the clinical decision-making process and post-surgery adaptation. Physician-patient communication (PPC) has been pointed out as a determinant factor in the decision-making to undergo RRSO, and the subsequent adjustment of women. However, studies examining the psychosocial impact of the decision-making process have been scarce and often lack clear theoretical frameworks. While the role of PPC in such processes has been highlighted in a few qualitative studies, there is a paucity of quantitative research addressing this question. Therefore, this narrative review, conducted using a multidisciplinary approach, was planned to: (1) present an updated medical background for RRSO; (2) analyze the psychosocial impact of the decision-making process within a theoretical framework of the Health Belief Model; and (3) discuss the role of PPC in such a decision-making process and in post-surgery. The collected research also enabled the recommendation of some additions to the existing clinical guidelines and the outlining of future research directions.
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Affiliation(s)
- Ana C. Alves-Nogueira
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal
- Correspondence:
| | - Daniela Melo
- Gynecology Clinic, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- Gynecology Department, Coimbra University Hospital Centre, 3004-561 Coimbra, Portugal
| | - Carlos Carona
- Center for Research in Neuropsychology and Cognitive and Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, s/n, 3000-115 Coimbra, Portugal
| | - Margarida Figueiredo-Dias
- Gynecology Clinic, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- Gynecology Department, Coimbra University Hospital Centre, 3004-561 Coimbra, Portugal
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Bommer C, Lupatsch J, Bürki N, Schwenkglenks M. Cost-utility analysis of risk-reducing strategies to prevent breast and ovarian cancer in BRCA-mutation carriers in Switzerland. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:807-821. [PMID: 34767113 PMCID: PMC9170622 DOI: 10.1007/s10198-021-01396-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 10/21/2021] [Indexed: 05/02/2023]
Abstract
OBJECTIVE We aimed to identify the most cost-effective of all prophylactic measures available in Switzerland for women not yet affected by breast and ovarian cancer who tested positive for a BRCA1/2 mutation. METHODS Prophylactic bilateral mastectomy (PBM), salpingo-oophorectomy (PBSO), combined PBM&PBSO and chemoprevention (CP) initiated at age 40 years were compared with intensified surveillance (IS). A Markov model with a life-long time horizon was developed from the perspective of the Swiss healthcare system using mainly literature-derived data to evaluate costs, quality-adjusted life years (QALYs) and survival. Costs and QALYs were discounted by 3% per year. Robustness of the results was tested with deterministic and probabilistic sensitivity analyses. RESULTS All prophylactic measures were found to be cost-saving with an increase in QALYs and life years (LYs) compared to IS. PBM&PBSO were found to be most cost-effective and dominated all other strategies in women with a BRCA1 or BRCA2 mutation. Lifetime costs averaged to 141,293 EUR and 14.5 QALYs per woman with a BRCA1 mutation under IS, versus 76,639 EUR and 19.2 QALYs for PBM&PBSO. Corresponding results for IS per woman with a BRCA2 mutation were 102,245 EUR and 15.5 QALYs, versus 60,770 EUR and 19.9 QALYs for PBM&PBSO. The results were found to be robust in sensitivity analysis; no change in the dominant strategy for either BRCA-mutation was observed. CONCLUSION All more invasive strategies were found to increase life expectancy and quality of life of women with a BRCA1 or BRCA2 mutation and were cost-saving for the Swiss healthcare system compared to IS.
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Affiliation(s)
- Claudine Bommer
- University of Zurich, Zürich, Switzerland.
- Department of Gynaecological Oncology, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | - Judith Lupatsch
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
| | - Nicole Bürki
- Gynaecological Tumor Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Matthias Schwenkglenks
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Klingelbergstrasse 61, 4056, Basel, Switzerland
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9
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Dibble KE, K. M. Donorfio L, Britner PA, Bellizzi KM. Perceptions and Care Recommendations from Previvors: Qualitative Analysis of Female BRCA1/2 Mutation Carriers’ Experience with Genetic Testing and Counseling. Gynecol Oncol Rep 2022; 41:100989. [PMID: 35540028 PMCID: PMC9079684 DOI: 10.1016/j.gore.2022.100989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/20/2022] [Accepted: 04/26/2022] [Indexed: 12/04/2022] Open
Abstract
BRCA1/2-positive women listed negative and positive aspects of testing/counseling. A wide range of emotions concerning healthcare experiences existed post-testing. Improved patient-oriented care and communication was recommended.
Introduction It is estimated that 12.5% of women will be diagnosed with breast cancer and 1.10% with ovarian cancer during their lifetime. Although less common, women with these mutations have a 11–72% increased risk of breast/ovarian cancers and are hereditary. Genetic testing/counseling presents the opportunity to identify carriers of BRCA1/2 genetic mutations before a cancer diagnosis. Methods Thirty-four BRCA1/2-positive women (with and without histories of breast/ovarian cancers) were recruited through online national support groups to gain a better understanding of their genetic testing/counseling perceptions and experiences. After confirming eligibility, they were invited to participate in either a telephone or webcam interview. Interview transcripts were analyzed using qualitative thematic text analysis and descriptive coding techniques. Results Six major themes emerged, capturing the perceptions and experiences of genetic testing/counseling for these women: 1) Emotional Reactions to Results and Genetic Counseling, 2) Future Recommendations, 3) Family Solidarity and Support, 4) Experiences with the Healthcare System, 5) Preventive Concerns and Decisions, and 6) Sources Affecting Perceived Risk. Two subthemes also emerged within the first theme, which are termed “Pre-vivor,” and “Testing Intuition.” Conclusions Participants indicated that genetic testing/counseling improvements would be helpful for women in this population surrounding quality care, including sensitivity training for healthcare professionals involved in testing/counseling, additional educational resources, and increased emotional and financial support. Although these recommendations may be beneficial, more widespread research with greater generalizability to disparate groups may be necessary prior to implementation.
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10
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Zarbo C, Brugnera A, Frigerio L, Celi C, Compare A, Dessì V, Giordano R, Malandrino C, Sina FP, Strepparava MG, Tessitore IV, Ventura M, Fruscio R. Cancer Anxiety Mediates the Association Between Satisfaction With Medical Communication and Psychological Quality of Life After Prophylactic Bilateral Salpingo-Oophorectomy. Front Psychol 2022; 13:840931. [PMID: 35356354 PMCID: PMC8959915 DOI: 10.3389/fpsyg.2022.840931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background Prophylactic Bilateral Salpingo-Oophorectomy (PBSO) reduces the risk of developing ovarian cancer. However, the psychological mechanisms that may affect post-surgery Quality of Life (QoL) among patients who underwent PBSO are still largely unknown. Thus, this study aimed at exploring the direct and indirect associations of satisfaction with medical communication and cancer anxiety on post-surgery QoL among women at high risk of developing ovarian cancer. Method Fifty-nine women (mean age: 50.64 ± 6.7 years) who underwent PBSO took part in this cross-sectional study, filling out a sociodemographic and clinical questionnaire, a battery of validated psychological measures and an ad hoc developed scale for the assessment of cancer anxiety. We first examined the correlations among all variables of interest, and then tested if cancer anxiety mediated the association between satisfaction with medical communication and post-surgery psychological QoL, controlling both for time from surgery and education. Results Post-surgery psychological QoL was unrelated from any sociodemographic or clinical variable. Cancer anxiety had a significant direct negative effect on psychological QoL, while satisfaction with medical communication had a significant positive direct effect on it. Finally, cancer anxiety significantly mediated the association between satisfaction with medical communication and post-surgery psychological QoL. Discussion Results suggest that post-surgery psychological QoL of patients who underwent PBSO may be increased with interventions, delivered in a genetic counselling setting, targeting quality of medical communication and cancer anxiety.
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Affiliation(s)
- Cristina Zarbo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Agostino Brugnera
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Luigi Frigerio
- Department of Obstetrics & Gynaecology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Celi
- Clinical Psychology Unit, ASST-Monza, Monza, Italy
| | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Valentina Dessì
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Rosalba Giordano
- Department of Obstetrics & Gynaecology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Chiara Malandrino
- Department of Obstetrics & Gynaecology, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Maria Grazia Strepparava
- Clinical Psychology Unit, ASST-Monza, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | | | | | - Robert Fruscio
- Gynaecologic Surgery Unit, ASST-Monza, Monza, Italy.,Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
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11
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van Bommel MHD, Steenbeek MP, IntHout J, Hermens RPMG, Hoogerbrugge N, Harmsen MG, van Doorn HC, Mourits MJE, van Beurden M, Zweemer RP, Gaarenstroom KN, Slangen BFM, Brood-van Zanten MMA, Vos MC, Piek JM, van Lonkhuijzen LRCW, Apperloo MJA, Coppus SFPJ, Prins JB, Custers JAE, de Hullu JA. Cancer worry among BRCA1/2 pathogenic variant carriers choosing surgery to prevent tubal/ovarian cancer: course over time and associated factors. Support Care Cancer 2022; 30:3409-3418. [PMID: 34997316 PMCID: PMC8857097 DOI: 10.1007/s00520-021-06726-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/26/2021] [Indexed: 11/03/2022]
Abstract
Objective High cancer risks, as applicable to BRCA1 and BRCA2 pathogenic variant (PV) carriers, can induce significant cancer concerns. We examined the degree of cancer worry and the course of this worry among BRCA1/2-PV carriers undergoing surgery to prevent ovarian cancer, and identified factors associated with high cancer worry. Methods Cancer worry was evaluated as part of the multicentre, prospective TUBA-study (NCT02321228) in which BRCA1/2-PV carriers choose either novel risk-reducing salpingectomy with delayed oophorectomy or standard risk-reducing salpingo-oophorectomy. The Cancer Worry Scale was obtained before and 3 and 12 months after surgery. Cancer worry patterns were analysed using latent class growth analysis and associated factors were identified with regression analysis. Results Of all 577 BRCA1/2-PV carriers, 320 (57%) had high (≥ 14) cancer worry pre-surgery, and 54% had lower worry 12 months post-surgery than pre-surgery. Based on patterns over time, BRCA1/2-PV carriers could be classified into three groups: persistently low cancer worry (56%), persistently high cancer worry (6%), and fluctuating, mostly declining, cancer worry (37%). Factors associated with persistently high cancer concerns were age below 35 (BRCA1) or 40 (BRCA2), unemployment, previous breast cancer, lower education and a more recent BRCA1/2-PV diagnosis. Conclusions Some degree of cancer worry is considered normal, and most BRCA1/2-PV carriers have declining cancer worry after gynaecological risk-reducing surgery. However, a subset of these BRCA1/2-PV carriers has persisting major cancer concerns up to 1 year after surgery. They should be identified and potentially offered additional support. Clinical trial registration The TUBA-study is registered at ClinicalTrials.gov since December 11th, 2014. Registration number: NCT02321228. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-021-06726-4.
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Affiliation(s)
- Majke H D van Bommel
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Miranda P Steenbeek
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Joanna IntHout
- Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Rosella P M G Hermens
- Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marline G Harmsen
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Helena C van Doorn
- Department of Gynaecology, Erasmus MC Cancer Clinic, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Marian J E Mourits
- Department of Gynaecologic Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Marc van Beurden
- Center for Gynaecological Oncology Amsterdam (CGOA), Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Ronald P Zweemer
- Department of Gynaecological Oncology, UMC Utrecht Cancer Center, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Katja N Gaarenstroom
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Brigitte F M Slangen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center, GROW-School for Oncology and Developmental Biology, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands
| | - Monique M A Brood-van Zanten
- Center for Gynaecological Oncology Amsterdam (CGOA), Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Center for Gynaecological Oncology Amsterdam (CGOA), AmsterdamUMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M Caroline Vos
- Gynaecologic Oncologic Center South Location Elisabeth-TweeSteden Hospital, Hilvarenbeekseweg 60, 5000 LC, Tilburg, The Netherlands
| | - Jurgen M Piek
- Gynaecologic Oncologic Center South Location Catharina Hospital, Department of Obstetrics and Gynaecology and Catharina Cancer Institute, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Luc R C W van Lonkhuijzen
- Center for Gynaecological Oncology Amsterdam (CGOA), AmsterdamUMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mirjam J A Apperloo
- Department of Obstetrics and Gynaecology, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD, Leeuwarden, The Netherlands
| | - Sjors F P J Coppus
- Department of Obstetrics and Gynaecology, Maxima Medical Center, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud Institute F Or Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - José A E Custers
- Department of Medical Psychology, Radboud Institute F Or Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Joanne A de Hullu
- Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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12
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Kotsopoulos J, Kim SJ, Armel S, Bordeleau L, Foulkes WD, McKinnon W, Panchal S, Cohen SA, Sun S, Sun P, McKetton L, Troyer AK, Narod SA. An evaluation of memory and attention in BRCA mutation carriers using an online cognitive assessment tool. Cancer 2021; 127:3183-3193. [PMID: 34077552 DOI: 10.1002/cncr.33654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the impact of various surgical, hormonal, and lifestyle factors on memory and attention in women with a BRCA1 or BRCA2 mutation. METHODS BRCA mutation carriers enrolled in a longitudinal study were invited to complete an online brain health assessment tool designed to screen for cognitive deficits. Four measures of memory and executive attention were assessed individually, and an overall score was compiled adjusting for age. Exposures, including preventive surgery, hormone use, and lifestyle factors, were captured by questionnaire. Performance on each of the 5 subtasks was analyzed according to various exposures. Analysis of covariance was used to compare overall scores. RESULTS In total, 880 women completed the online cognitive assessment. The average age of the participants was 54 years (range, 23-86 years). The mean overall test score was 54.4 (range, 0-93). The individual subtask scores declined with age at test completion (P < .0001) and increased with level of education (P ≤ .01). Women who underwent a preventive oophorectomy had a significantly higher overall score compared with women who did not undergo this surgery (55.5 vs 50.5; P = .01). Reconstructive breast surgery was also associated with a higher overall score (56.5 vs 52.3; P = .005). Chemotherapy and hormone-replacement therapy were not predictive of the overall score. CONCLUSIONS These findings are reassuring to high-risk women who undergo early surgical menopause for their cancer predisposition. Further studies are needed to evaluate cognitive function over time when memory deficits become more prevalent.
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Affiliation(s)
- Joanne Kotsopoulos
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Shana J Kim
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Susan Armel
- Division of Gynecologic Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Louise Bordeleau
- Division of Medical Oncology, Juravinski Cancer Center, Hamilton, Ontario, Canada
| | - William D Foulkes
- Program in Cancer Genetics, Department of Oncology and Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Wendy McKinnon
- Familial Cancer Program, University of Vermont Medical Center, Burlington, Vermont
| | - Seema Panchal
- Marvelle Koffler Breast Center, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Stephanie A Cohen
- Cancer Genetics Risk Assessment Program, St Vincent Health, Indianapolis, Indiana
| | - Sophie Sun
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Ping Sun
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Angela K Troyer
- Neuropsychology and Cognitive Health Program, Baycrest Center for Geriatric Care, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Steven A Narod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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13
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Chae S, Kim EK, Jang YR, Lee AS, Kim SK, Suh DH, Kim K, No JH, Kim YB, Kim SW, Kang E. Effect of risk-reducing salpingo-oophorectomy on the quality of life in Korean BRCA mutation carriers. Asian J Surg 2021; 44:1056-1062. [PMID: 33573923 DOI: 10.1016/j.asjsur.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/26/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study aimed to compare the quality of life (QOL), psychosocial status, sexual function, and menopausal symptoms between the risk-reducing salpingo-oophorectomy (RRSO) and non-RRSO groups comprising BRCA mutation carriers and to evaluate the effect of timing of RRSO on those aspects. METHODS This cross-sectional study recruited BRCA mutation carriers aged ≥35 years between September 2015 and September 2016. Demographic data of carriers were collected. Outcomes were measured using the questionnaires addressing QOL, anxiety, depression, optimism, sexual function, and menopausal symptoms. RESULTS Of 52 participants, 30 (57.7%) underwent RRSO, whereas 22 (42.3%) did not. In the RRSO group, 16 (53.3%) and 14 (46.7%) women underwent RRSO before and after menopause, respectively. The mean age in the RRSO group was higher than that in the non-RRSO group (49.8 vs. 42.1 years, respectively, p = 0.002). The scores for QOL, anxiety, depression, optimism, sexual function, and menopausal symptoms were similar between both groups. In the multivariate analysis, RRSO uptake was associated with worse physical QOL (coefficient, -5.350; 95% confidence interval, -10.593 to -0.108). With respect to the timing of RRSO, only the mental QOL was significantly lower in the postmenopausal RRSO group than in the premenopausal RRSO group (39.2 vs. 43.7, respectively, p = 0.043). CONCLUSION We could not find any difference in mental QOL, psychosocial status, sexual function, and menopausal symptoms between the RRSO and non-RRSO groups. RRSO uptake only affected worse physical QOL. These results will help physicians counsel BRCA mutation carriers about the effect of RRSO on QOL.
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Affiliation(s)
- Sumin Chae
- Department of Surgery, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, South Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ye Rang Jang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Angela Soeun Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seul Ki Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jae Hong No
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Beom Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sung-Won Kim
- Department of Surgery, Daerim St. Mary's Hospital, Seoul, South Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
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14
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Hickey I, Jha S, Wyld L. The psychosexual effects of risk-reducing bilateral salpingo-oophorectomy in female BRCA1/2 mutation carriers: A systematic review of qualitative studies. Gynecol Oncol 2020; 160:763-770. [PMID: 33317909 DOI: 10.1016/j.ygyno.2020.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION It is estimated that up to 20% of ovarian cancers have an inherited genetic etiology with the most common being BRCA1/2 mutations. For women with these mutations risk-reducing bilateral salpingo-oophorectomy (RRBSO) to reduce the risk of primary ovarian cancer is often performed, however the surgery results in immediate onset of surgical menopause. AIM The aim of this systematic review was to explore the psychosexual impacts of risk reducing bilateral salpingo oophorectomy in the published qualitative literature. METHODS PubMed, Medline, Web of Science and PsycInfo were searched for qualitative papers that looked at the psychosexual impact of RRBSO on individuals who were pre-menopausal at the time of surgery. Studies were quality assessed using Mixed Method Appraisal Tool (MMAT) and Standard for Reporting Qualitative Research (SRQR) checklists and data were extracted. Thematic synthesis of the results was performed. RESULTS Of 143 papers identified in searching, 5 qualitative papers were identified relating to interviews with 115 women after RRBSO published between 2000 and 2020. The quality of the papers was moderate. Five different themes were identified related to individual experiences with RRBSO: (1) information needs, (2) psychological impact, (3) psychosexual impact, (4) partner support and (5) hormone replacement therapy (HRT). CONCLUSION Individual experiences of RRBSO were varied and influenced by multiple factors but psychosexual problems were common, often caused significant distress to the women and their partners and were often poorly explained before surgery. Women do not feel adequately prepared for the psychological and sexual side effects of RRBSO. The qualitative data provides invaluable insight into the individual experiences of women and can be used to better help women mitigate the effects of the surgery.
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Affiliation(s)
- India Hickey
- University of Sheffield, Department of Oncology and Metabolism, Academic Unit of Reproductive and Developmental Medicine, UK.
| | - Swati Jha
- Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Hospital for Women, Sheffield, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield S10 2RX, UK; Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Armthorpe Road, Doncaster, UK
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15
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Gaba F, Blyuss O, Chandrasekaran D, Osman M, Goyal S, Gan C, Izatt L, Tripathi V, Esteban I, McNicol L, Ragupathy K, Crawford R, Evans DG, Legood R, Menon U, Manchanda R. Attitudes towards risk-reducing early salpingectomy with delayed oophorectomy for ovarian cancer prevention: a cohort study. BJOG 2020; 128:714-726. [PMID: 32803845 DOI: 10.1111/1471-0528.16424] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine risk-reducing early salpingectomy and delayed oophorectomy (RRESDO) acceptability and effect of surgical prevention on menopausal sequelae/satisfaction/regret in women at increased ovarian cancer (OC) risk. DESIGN Multicentre, cohort, questionnaire study (IRSCTN:12310993). SETTING United Kingdom (UK). POPULATION UK women without OC ≥18 years, at increased OC risk, with/without previous RRSO, ascertained through specialist familial cancer/genetic clinics and BRCA support groups. METHODS Participants completed a 39-item questionnaire. Baseline characteristics were described using descriptive statistics. Logistic/linear regression models analysed the impact of variables on RRESDO acceptability and health outcomes. MAIN OUTCOMES RRESDO acceptability, menopausal sequelae, satisfaction/regret. RESULTS In all, 346 of 683 participants underwent risk-reducing salpingo-oophorectomy (RRSO). Of premenopausal women who had not undergone RRSO, 69.1% (181/262) found it acceptable to participate in a research study offering RRESDO. Premenopausal women concerned about sexual dysfunction were more likely to find RRESDO acceptable (odds ratio [OR] = 2.9, 95% CI 1.2-7.7, P = 0.025). 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). In all, 88.8% (143/161) premenopausal and 95.2% (80/84) postmenopausal women who underwent RRSO, respectively, were satisfied with their decision, whereas 9.4% (15/160) premenopausal and 1.2% (1/81) postmenopausal women who underwent RRSO regretted their decision. HRT uptake in premenopausal individuals without breast cancer (BC) was 74.1% (80/108). HRT use did not significantly affect satisfaction/regret levels but did reduce 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 for postmenopausal women. HRT use following premenopausal RRSO does not increase satisfaction but does reduce vaginal dryness. TWEETABLE ABSTRACT RRESDO has high acceptability among premenopausal women at increased ovarian cancer risk, particularly those concerned about sexual dysfunction.
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Affiliation(s)
- F Gaba
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - O Blyuss
- School of Physics, Astronomy and Mathematics, University of Hertfordshire, Hatfield, UK.,Department of Paediatrics and Paediatric Infectious Diseases, Sechenov First Moscow State Medical University, Moscow, Russia.,Department of Applied Mathematics, Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
| | - D Chandrasekaran
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - M Osman
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK
| | - S Goyal
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK
| | - C Gan
- Department of Gynaecological Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - L Izatt
- Department of Clinical Genetics, Guy's Hospital, London, UK
| | - V Tripathi
- Department of Clinical Genetics, Guy's Hospital, London, UK
| | - I Esteban
- Ninewells Hospital, NHS Tayside, Dundee, UK
| | - L McNicol
- Ninewells Hospital, NHS Tayside, Dundee, UK
| | | | - R Crawford
- Department of Gynaecological Oncology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - D G Evans
- Manchester Centre for Genomic Medicine, MAHSC, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK
| | - R Legood
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - U Menon
- MRC Clinical Trials Unit, University College London, London, UK
| | - R Manchanda
- Wolfson Institute of Preventive Medicine, Cancer Research UK, Barts Centre, Queen Mary University of London, Charterhouse Square, London, UK.,Department of Gynaecological Oncology, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.,MRC Clinical Trials Unit, University College London, London, UK
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16
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Gaba F, Manchanda R. Systematic review of acceptability, cardiovascular, neurological, bone health and HRT outcomes following risk reducing surgery in BRCA carriers. Best Pract Res Clin Obstet Gynaecol 2020; 65:46-65. [DOI: 10.1016/j.bpobgyn.2020.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 02/08/2023]
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17
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Abildgaard J, Ahlström MG, Nielsen DL, Daugaard G, Lindegaard B, Obel N, Lidegaard Ø. Use of antidepressants in women after prophylactic bilateral oophorectomy: A Danish national cohort study. Psychooncology 2020; 29:655-662. [PMID: 31733110 DOI: 10.1002/pon.5290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/09/2019] [Accepted: 11/12/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the association between prophylactic bilateral oophorectomy and use of antidepressants in women with a family history of cancer. METHODS Nationwide population-based cohort study using Danish National Registries including women oophorectomized due to a family history of cancer (n = 2,002) and an age matched reference group (n = 18,018). Analyses were stratified by age at time of bilateral oophorectomy and use of hormone replacement therapy (HRT). RESULTS Women oophorectomized at age ≤ 45 years were more likely to use antidepressants from the first year after bilateral oophorectomy (OR = 1.34; 95 % CI: 1.08-1.65) compared to the reference group. Women oophorectomized at age 46-55 years and at age >55 years had no significantly increased use of antidepressants (OR = 0.90; 95 % CI: 0.68-1.18 and OR = 1.14; 95 % CI: 0.81-1.61). The increased use of antidepressants in women oophorectomized at age ≤ 45 years was limited to women treated with HRT (OR = 1.51; 95 % CI: 1.18-1.94) whereas women oophorectomized at age ≤ 45 years not treated with HRT had no increased use of antidepressants (OR = 1.03; 95 % CI: 0.70-1.51). CONCLUSIONS Women oophorectomized due to a family history of cancer at age ≤ 45 years were more likely to use antidepressants after bilateral oophorectomy. The increased use of antidepressants was limited to women treated with HRT. The study calls for further large-scale studies to understand how bilateral oophorectomy and concomitant HRT affects risk of depression in women with a family history of cancer.
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Affiliation(s)
- Julie Abildgaard
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Dorte Lisbeth Nielsen
- Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Gedske Daugaard
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Lindegaard
- The Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Pulmonary and Infectious Diseases, Nordsjaellands Hospital, Hillerød, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Øjvind Lidegaard
- Department of GynecologyRigshospitalet, University of Copenhagen, Denmark
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18
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Does preventive oophorectomy increase the risk of depression in BRCA mutation carriers? ACTA ACUST UNITED AC 2020; 27:156-161. [DOI: 10.1097/gme.0000000000001437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Mai PL, Huang HQ, Wenzel LB, Han PK, Moser RP, Rodriguez GC, Boggess J, Rutherford TJ, Cohn DE, Kauff ND, Phillips KA, Wilkinson K, Wenham RM, Hamilton C, Powell MA, Walker JL, Greene MH, Hensley ML. Prospective follow-up of quality of life for participants undergoing risk-reducing salpingo-oophorectomy or ovarian cancer screening in GOG-0199: An NRG Oncology/GOG study. Gynecol Oncol 2020; 156:131-139. [PMID: 31759774 PMCID: PMC6980744 DOI: 10.1016/j.ygyno.2019.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/08/2019] [Accepted: 10/22/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Risk-reducing salpingo-oophorectomy (RRSO) and ovarian cancer screening (OCS) are management options for women at increased risk of ovarian cancer. Long-term effects of these interventions on quality of life (QOL) are not well understood. METHODS GOG-0199 is a prospective cohort study of women at increased ovarian cancer risk who chose either RRSO or OCS as their risk management intervention. At study entry, 6, 12, 24 and 60 months of follow-up, participants completed the QOL questionnaire, which included the Medical Outcome Study Short Form-36, the Impact of Events Scales, the Center for Epidemiological Studies Depression Scale, the State-Trait Anxiety Inventory, the Functional Assessment of Cancer Therapy - Endocrine Subscale, and the Sexual Activity Questionnaire. QOL measures were compared between the RRSO and OCS cohort at baseline and over time. RESULTS Five-hundred-sixty-two participants in the RRSO cohort and 1,010 in the OCS completed the baseline and at least one follow-up questionnaire. At baseline, participants selecting RRSO reported lower health-related QOL (HRQOL), greater ovarian cancer-related stress, greater anxiety, and more depressive symptomatology, which improved during follow-up, especially for ovarian cancer-related stress. Screening was not found to adversely impact HRQOL. Hormone-related menopausal symptoms worsened and sexual functioning declined during follow-up in both cohorts, but more so among participants who underwent RRSO. CONCLUSIONS HRQOL improved after surgery among women who chose RRSO and remained stable among participants undergoing screening. The adverse effects of RRSO and screening on short-term and long-term sexual activity and sexual functioning warrant consideration in the decision-making process for high-risk women.
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Affiliation(s)
- Phuong L Mai
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20850-9772, USA.
| | - Helen Q Huang
- NRG Oncology, Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY, 14263-0001, USA.
| | - Lari B Wenzel
- Center for Health Policy Research, University of California, Irvine, Irvine CA, 92697, USA.
| | - Paul K Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, 04101, USA.
| | - Richard P Moser
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, 20850-9761, USA.
| | - Gustavo C Rodriguez
- Division of Gynecologic Oncology, North Shore University Health System; Evanston, IL, 60201, USA.
| | - John Boggess
- Division of Gynecologic Oncology, University of North Carolina at Chapel Hill; Raleigh NY 27607, USA.
| | | | - David E Cohn
- Ohio State University, Columbus Cancer Council; GYN Oncology; Columbus, OH, 43026, USA.
| | - Noah D Kauff
- Gynecologic Medical Oncology Service, Memorial Sloan-Kettering Cancer Center; Surgery Department; New York, NY, 10065, USA.
| | - Kelly-Anne Phillips
- Peter MacCallum Cancer Centre, Division of Cancer Medicine, Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, 300 AU, Australia.
| | - Kelly Wilkinson
- University of Mississippi Medical Center, Dept. of Hematology/Oncology, Jackson, MS, 39216, USA.
| | - Robert M Wenham
- H. Lee Moffitt Cancer Center & Research Institute, Gynecology Oncology Division; Tampa, FL, 33612-9497, USA.
| | - Chad Hamilton
- Walter Reed Army Medical Center, Bethesda, MD, 20889, USA.
| | - Matthew A Powell
- Washington University School of Medicine, Saint Louis, MO, 63110, USA.
| | - Joan L Walker
- Stephenson Cancer Center, Department of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.
| | - Mark H Greene
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD, 20850-9772, USA.
| | - Martee L Hensley
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY, 10065, USA.
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Stanisz M, Panczyk M, Kurzawa R, Grochans E. The Effect of Prophylactic Adnexectomy on the Quality of Life and Psychosocial Functioning of Women with the BRCA1/BRCA2 Mutations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244995. [PMID: 31818005 PMCID: PMC6950418 DOI: 10.3390/ijerph16244995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 12/21/2022]
Abstract
The main purpose of this study was to analyze the effect of risk-reducing salpingo-oophorectomy (RRSO) on the quality of life (QoL) and psychosocial functioning of patients with the BRCA1/BRCA2 mutations. This survey-based study was conducted using the Blatt-Kupperman Index, the Women’s Health Questionnaire, the Perceived Stress Scale, the State-Trait Anxiety Inventory, the Beck Depression Inventory-II, and the authors’ questionnaire. All calculations were done using Statistica 13.3. The QoL after RRSO was statistically significantly lower in most domains compared with the state before surgery. The greatest decline in the QoL was observed in the vasomotor symptoms domain (d = 0.953) and the smallest in the memory/concentration domain (d = 0.167). We observed a statistically significant decrease in the level of anxiety as a state (d = 0.381), as well as a statistically significant increase in the severity of climacteric symptoms (d = 0.315) and depressive symptoms (d = 0.125). Prophylactic surgeries of the reproductive organs have a negative effect on the QoL and psychosocial functioning of women with the BRCA1/2 mutations, as they increase the severity of depressive and climacteric symptoms. At the same time, these surgeries reduce anxiety as a state, which may be associated with the elimination of cancerophobia.
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Affiliation(s)
- Marta Stanisz
- Department of Gynecology and Reproductive Health, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (M.S.); (R.K.)
| | - Mariusz Panczyk
- Department of Education and Research in Health Sciences, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Rafał Kurzawa
- Department of Gynecology and Reproductive Health, Pomeranian Medical University in Szczecin, 71-210 Szczecin, Poland; (M.S.); (R.K.)
- Center of Gynecology and Treatmemt for Infertility “Vitrolive”, al. Wojska Polskiego 103, 70-483 Szczecin, Poland
| | - Elżbieta Grochans
- Department of Nursing, Pomeranian Medical University in Szczecin; ul. Żołnierska 48, 71-210 Szczecin, Poland
- Correspondence: ; Tel.: +48-91-4800-910
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21
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Powell CB, Alabaster A, Le A, Stoller N, Armstrong MA, Raine‐Bennett T. Sexual function, menopausal symptoms, depression and cancer worry in women with BRCA mutations. Psychooncology 2019; 29:331-338. [DOI: 10.1002/pon.5253] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/13/2019] [Accepted: 10/02/2019] [Indexed: 12/12/2022]
Affiliation(s)
- C. Bethan Powell
- Kaiser Permanente Northern California Gynecologic Cancer Program California United States of America
- Division of Research Kaiser Permanente Northern California California United States of America
| | - Amy Alabaster
- Division of Research Kaiser Permanente Northern California California United States of America
| | - Amy Le
- Kaiser Permanente Ob/Gyn Residency Program California United States of America
| | - Nicole Stoller
- Division of Research Kaiser Permanente Northern California California United States of America
| | - Mary Anne Armstrong
- Division of Research Kaiser Permanente Northern California California United States of America
| | - Tina Raine‐Bennett
- Division of Research Kaiser Permanente Northern California California United States of America
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Jeffers L, Reid J, Fitzsimons D, Morrison PJ, Dempster M. Interventions to improve psychosocial well-being in female BRCA-mutation carriers following risk-reducing surgery. Cochrane Database Syst Rev 2019; 10:CD012894. [PMID: 31595976 PMCID: PMC6784162 DOI: 10.1002/14651858.cd012894.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Women who carry a pathogenic mutation in either a BRCA1 DNA repair associated or BRCA2 DNA repair associated (BRCA1 or BRCA2) gene have a high lifetime risk of developing breast and tubo-ovarian cancer. To manage this risk women may choose to undergo risk-reducing surgery to remove breast tissue, ovaries, and fallopian tubes. Surgery should increase survival, but can impact women's lives adversely at the psychological and psychosexual levels. Interventions to facilitate psychological adjustment and improve quality of life post risk-reducing surgery are needed. OBJECTIVES To examine psychosocial interventions in female BRCA carriers who have undergone risk-reducing surgery and to evaluate the effectiveness of such interventions on psychological adjustment and quality of life. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE and Embase via Ovid, CINAHL, PsycINFO, Web of Science up to April 2019 and Scopus up to January 2018. We also handsearched abstracts of scientific meetings and other relevant publications. SELECTION CRITERIA We included randomised controlled trials (RCT), non-randomised studies (NRS), prospective and retrospective cohort studies and interventional studies using baseline and postintervention analyses in female BRCA carriers who have undergone risk-reducing surgery. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility studies for inclusion in the review. We used standard methodological procedures expected by Cochrane. MAIN RESULTS We screened 4956 records from the searches, selecting 34 unique studies for full-text scrutiny, of which two met the inclusion criteria: one RCT and one NRS. The included studies assessed 113 female BRCA carriers who had risk-reducing surgery, but there was attrition, and outcome data were not available for all participants at final study assessments. We assessed the RCT as at a high risk of bias whilst the NRS did not have a control group. Our GRADE assessment of the studies was very low-certainty due to the paucity of data and methodological shortcomings of the studies. The primary outcome of quality of life was only measured in the RCT and that was specific to the menopause. Both studies reported on psychological distress and sexual function. Neither study measured body image, perhaps because this is most often associated with risk-reducing mastectomy rather than oophorectomy.The RCT (66 participants recruited with 48 followed to 12 months) assessed the short- and long-term effects of an eight-week mindfulness-based stress reduction (MBSR) training programme on quality of life, sexual functioning, and sexual distress in female BRCA carriers (n = 34) in a specialised family cancer clinic in the Netherlands compared to female BRCA carriers (n = 32) who received usual care. Measurements on the Menopause-Specific Quality of Life Questionnaire (MENQOL) showed some improvement at 3 and 12 months compared to the usual care group. At 3 months the mean MENQOL scores were 3.5 (95% confidence interval (CI) 3.0 to 3.9) and 3.8 (95% CI 3.3 to 4.2) for the MBSR and usual care groups respectively, whilst at 12 months the corresponding values were 3.6 (95% CI 3.1 to 4.0) and 3.9 (95% CI 3.5 to 4.4) (1 study; 48 participants followed up at 12 months). However, these results should be interpreted with caution due to the very low-certainty of the evidence, where a lower score is better. Other outcome measures on the Female Sexual Function Index and the Female Sexual Distress Scale showed no significant differences between the two groups. Our GRADE assessment of the evidence was very low-certainty due to the lack of blinding of participants and personnel, attrition bias and self-selection (as only one-third of eligible women chose to participate in the study) and serious imprecision due to the small sample size and wide 95% CI.The NRS comprised 37 female BRCA carriers selected from three Boston-area hospitals who had undergone a novel sexual health intervention following risk-reducing salpingo-oophorectomy (RRSO) without a history of tubo-ovarian cancer. The intervention consisted of targeted sexual-health education, body awareness and relaxation training, and mindfulness-based cognitive therapy strategies, followed by two sessions of tailored telephone counselling. This was a single-arm study without a control group. Our GRADE assessment of the evidence was very low-certainty, and as there was no comparison group in the included study, we could not estimate a relative effect. The study reported change in psychosexual adjustment from baseline to postintervention (median 2.3 months) using measures of Female Sexual Function Index (n = 34), which yielded change with a mean of 3.91, standard deviation (SD) 9.12, P = 0.018 (1 study, 34 participants; very low-certainty evidence). The Brief Symptom Inventory, Global Severity Index yielded a mean change of 3.92, SD 5.94, P < 0.001. The Sexual Self-Efficacy Scale yielded change with a mean of 12.14, SD 20.56, P < 0.001. The Sexual Knowledge Scale reported mean change of 1.08, SD 1.50, P < 0.001 (n = 36). Participant satisfaction was measured by questionnaire, and 100% participants reported that they enjoyed taking part in the psychoeducation group and felt "certain" or "very certain" that they had learned new skills to help them cope with the sexual side effects of RRSO. AUTHORS' CONCLUSIONS The effect of psychosocial interventions on quality of life and emotional well-being in female BRCA carriers who undergo risk-reducing surgery is uncertain given the very low methodological quality in the two studies included in the review. The absence of such interventions highlights the need for partnership between researchers and clinicians in this specific area to take forward the patient-reported outcomes and develop interventions to address the psychosocial issues related to risk-reducing surgery in female BRCA carriers, particularly in this new era of genomics, where testing may become more mainstream and many more women are identified as gene carriers.
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Affiliation(s)
- Lisa Jeffers
- Regional Medical Genetics CentreMedical GeneticsBelfast Health and Social Care TrustLisburn RoadBelfastUKBT9 7AB
| | - Joanne Reid
- Queen's University BelfastSchool of Nursing and Midwifery10 Malone RoadBelfastUKBT9 5BN
| | - Donna Fitzsimons
- Queen's University BelfastSchool of Nursing and Midwifery10 Malone RoadBelfastUKBT9 5BN
| | - Patrick J Morrison
- Regional Medical Genetics CentreMedical GeneticsBelfast Health and Social Care TrustLisburn RoadBelfastUKBT9 7AB
- Queen's University BelfastCentre for Cancer Research and Cell Biology97 Lisburn RoadBelfastUKBT9 7AE
| | - Martin Dempster
- Queen's University BelfastSchool of PsychologyUniversity RoadBelfastNorthern IrelandUKBT7 1NN
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Kotsopoulos J, Hall E, Finch A, Hu H, Murphy J, Rosen B, Narod SA, Cheung AM. Changes in Bone Mineral Density After Prophylactic Bilateral Salpingo-Oophorectomy in Carriers of a BRCA Mutation. JAMA Netw Open 2019; 2:e198420. [PMID: 31390031 PMCID: PMC6686775 DOI: 10.1001/jamanetworkopen.2019.8420] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Preventive surgery is strongly recommended for individuals with a BRCA mutation at a young age to prevent ovarian cancer and improve overall survival. The overall effect of early surgical menopause on various health outcomes, including bone health, has not been clearly elucidated. OBJECTIVE To evaluate the association of prophylactic bilateral salpingo-oophorectomy with bone mineral density (BMD) loss among individuals with a BRCA mutation. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of participants with a BRCA mutation who underwent oophorectomy through the University Health Network, Toronto, Ontario, Canada, recruited participants from January 2000 to May 2013. Eligibility criteria included having a BRCA mutation, at least 1 ovary intact prior to surgery, and no history of any cancer other than breast cancer. Bone mineral density was measured using dual-energy x-ray absorptiometry before and after surgery. Data analysis began in December 2018 and finished in January 2019. MAIN OUTCOMES AND MEASURES The annual change in BMD from baseline to follow-up was calculated for the following 3 anatomical locations: (1) lumbar spine, (2) femoral neck, and (3) total hip. RESULTS A total of 95 women had both a baseline and postsurgery BMD measurement with a mean (SD) follow-up period of 22.0 (12.7) months. The mean (SD) age at oophorectomy was 48.0 (7.4) years. Among women who were premenopausal at time of surgery (50 [53%]), there was a decrease in BMD from baseline to follow-up across the lumbar spine (annual change, -3.45%; 95% CI, -4.61% to -2.29%), femoral neck (annual change, -2.85%; 95% CI, -3.79% to -1.91%), and total hip (annual change, -2.24%; 95% CI, -3.11% to -1.38%). Self-reported hormone therapy use was associated with significantly less bone loss at the lumbar spine (-2.00% vs -4.69%; P = .02) and total hip (-1.38% vs -3.21; P = .04) compared with no hormone therapy use. Among postmenopausal women at time of surgery (45 [47%]), there was also a significant decrease in BMD across the lumbar spine (annual change, -0.82%; 95% CI, -1.42% to -0.23%) and femoral neck (annual change, -0.68%; 95% CI, -1.33% to -0.04%) but not total hip (annual change, -0.18%; 95% CI, -0.82% to 0.46%). CONCLUSIONS AND RELEVANCE This study found that oophorectomy was associated with postoperative bone loss, especially among women who were premenopausal at the time of surgery. Targeted management strategies should include routine BMD assessment and hormone therapy use to improve management of bone health in this population.
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Affiliation(s)
- Joanne Kotsopoulos
- Women’s College Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Hall
- Women’s College Research Institute, Toronto, Ontario, Canada
| | - Amy Finch
- Women’s College Research Institute, Toronto, Ontario, Canada
| | - Hanxian Hu
- Osteoporosis Program, University Health Network, Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, Ontario, Canada
| | - Joan Murphy
- Department of Gynecology Oncology, Princess Margaret Cancer Center, Toronto, Ontario, Canada
| | - Barry Rosen
- Osteoporosis Program, University Health Network, Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, Ontario, Canada
| | - Steven A. Narod
- Women’s College Research Institute, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Angela M. Cheung
- Osteoporosis Program, University Health Network, Centre of Excellence in Skeletal Health Assessment, University of Toronto, Toronto, Ontario, Canada
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Manoukian S, Alfieri S, Bianchi E, Peissel B, Azzollini J, Borreani C. Risk‐reducing surgery in
BRCA1
/
BRCA2
mutation carriers: Are there factors associated with the choice? Psychooncology 2019; 28:1871-1878. [DOI: 10.1002/pon.5166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/17/2019] [Accepted: 06/25/2019] [Indexed: 01/07/2023]
Affiliation(s)
- Siranoush Manoukian
- Unit of Medical Genetics, Department of Medical Oncology and HematologyFondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Sara Alfieri
- Clinical Psychlogy UnitFondazione IRCSS Istituto Nazionale dei Tumori Milan Italy
| | - Elisabetta Bianchi
- Clinical Psychlogy UnitFondazione IRCSS Istituto Nazionale dei Tumori Milan Italy
| | - Bernard Peissel
- Unit of Medical Genetics, Department of Medical Oncology and HematologyFondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Jacopo Azzollini
- Unit of Medical Genetics, Department of Medical Oncology and HematologyFondazione IRCCS Istituto Nazionale dei Tumori Milan Italy
| | - Claudia Borreani
- Clinical Psychlogy UnitFondazione IRCSS Istituto Nazionale dei Tumori Milan Italy
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Samadder NJ, Giridhar KV, Baffy N, Riegert-Johnson D, Couch FJ. Hereditary Cancer Syndromes-A Primer on Diagnosis and Management: Part 1: Breast-Ovarian Cancer Syndromes. Mayo Clin Proc 2019; 94:1084-1098. [PMID: 31171119 DOI: 10.1016/j.mayocp.2019.02.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 02/05/2019] [Accepted: 02/14/2019] [Indexed: 12/12/2022]
Abstract
Cancer is the second leading cause of death in both men and women in the United States, with colorectal cancer and breast cancer being two of the most frequent cancer types. Hereditary causes occurring due to pathogenic sequence variants and defects in certain genes makes up roughly 5% of all colorectal cancers and breast-ovarian cancers. High-risk hereditary predisposition syndromes have been associated with a substantially increased lifetime risk for the development of colorectal cancers and breast-ovarian cancers depending on the genetic syndrome, and many people also carry an increased risk of several other cancers compared with the general population. The aim of this review was to provide comprehensive literature on the most commonly encountered hereditary predisposition syndromes, including Lynch syndrome, familial adenomatous polyposis, MUTYH-associated polyposis, hamartomatous polyposis, and breast-ovarian cancer conditions. This will be presented as a 2-part series: the first part will cover the breast-ovarian cancer syndromes, and the second will focus on the inherited colorectal cancer and polyposis conditions.
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Affiliation(s)
- N Jewel Samadder
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ; Department of Clinical Genomics, Mayo Clinic, Scottsdale, AZ; Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL.
| | | | - Noemi Baffy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ
| | - Douglas Riegert-Johnson
- Department of Clinical Genomics, Mayo Clinic, Scottsdale, AZ; Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL; Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL
| | - Fergus J Couch
- Department of Laboratory Medicine, Mayo Clinic, Rochester, MN
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Clinical background and outcomes of risk-reducing salpingo-oophorectomy for hereditary breast and ovarian cancers in Japan. Int J Clin Oncol 2019; 24:1105-1110. [DOI: 10.1007/s10147-019-01456-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 04/23/2019] [Indexed: 01/13/2023]
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Hanley GE, McAlpine JN, Cheifetz R, Schrader KA, McCullum M, Huntsman D. Selected medical interventions in women with a deleterious BRCA mutation: a population-based study in British Columbia. ACTA ACUST UNITED AC 2019; 26:e17-e23. [PMID: 30853805 DOI: 10.3747/co.26.4068] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background We examined the uptake of risk-reducing interventions, including bilateral mastectomy, risk-reducing salpingo-oophorectomy, oral contraceptive pills, tamoxifen, and raloxifene, for the entire population of women with a deleterious BRCA1 or BRCA2 mutation in the Canadian province of British Columbia. Methods This retrospective population-based study used data available in British Columbia for all women who, between 1996 and 2014, were tested and found to have a BRCA mutation. Rates of risk-reducing interventions stratified according to the type of BRCA mutation and prior history of breast or gynecologic cancer (ovary, fallopian tube, peritoneal) are presented. Cancers diagnosed in women with a BRCA mutation after disclosure of their mutation status are also presented. Results The final study cohort consisted of 885 patients with a deleterious BRCA1 (n = 474) or BRCA2 (n = 411) mutation. Of the women with no prior breast cancer, 30.8% carrying a BRCA1 mutation and 28.3% carrying a BRCA2 mutation underwent bilateral mastectomy. Of women with no prior gynecologic cancer, 64.7% carrying a BRCA1 mutation and 62.2% carrying a BRCA2 mutation underwent risk-reducing bilateral salpingo-oophorectomy. Rates of chemoprevention with oral contraceptive pills and tamoxifen or raloxifene were low in all groups. In this cohort, 23 gynecologic and 70 breast cancers were diagnosed after disclosure of BRCA mutation status. Conclusions Our results suggest reasonable uptake of risk-reducing interventions in high-risk women. To minimize the occurrence of breast and ovarian cancer in women with a BRCA1 or BRCA2 mutation, more attention could be paid to ensuring that affected women receive proper counselling and follow-up.
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Affiliation(s)
- G E Hanley
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - J N McAlpine
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - R Cheifetz
- Department of Surgery, University of British Columbia, Vancouver, BC.,BC Cancer, Hereditary Cancer Program, High-Risk Clinic, Vancouver, BC
| | - K A Schrader
- Department of Medical Genetics, University of British Columbia, Vancouver, BC.,BC Cancer, Hereditary Cancer Program, Vancouver, BC
| | - M McCullum
- Department of Surgery, University of British Columbia, Vancouver, BC
| | - D Huntsman
- Laboratory Medicine, University of British Columbia, Vancouver, BC
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Hall E, Finch A, Jacobson M, Rosen B, Metcalfe K, Sun P, Narod SA, Kotsopoulos J. Effects of bilateral salpingo-oophorectomy on menopausal symptoms and sexual functioning among women with a BRCA1 or BRCA2 mutation. Gynecol Oncol 2019; 152:145-150. [DOI: 10.1016/j.ygyno.2018.10.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 10/24/2018] [Accepted: 10/29/2018] [Indexed: 12/31/2022]
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Jacobson M, Bernardini M, Sobel ML, Kim RH, McCuaig J, Allen L. No. 366-Gynaecologic Management of Hereditary Breast and Ovarian Cancer. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1497-1510. [DOI: 10.1016/j.jogc.2018.05.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Jacobson M, Bernardini M, Sobel ML, Kim RH, McCuaig J, Allen L. No 366 - Prise en charge gynécologique du cancer du sein et de l'ovaire héréditaire. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1511-1527. [DOI: 10.1016/j.jogc.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Eleje GU, Eke AC, Ezebialu IU, Ikechebelu JI, Ugwu EO, Okonkwo OO. Risk-reducing bilateral salpingo-oophorectomy in women with BRCA1 or BRCA2 mutations. Cochrane Database Syst Rev 2018; 8:CD012464. [PMID: 30141832 PMCID: PMC6513554 DOI: 10.1002/14651858.cd012464.pub2] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The presence of deleterious mutations in breast cancer 1 gene (BRCA1) or breast cancer 2 gene (BRCA2) significantly increases the risk of developing some cancers, such as breast and high-grade serous cancer (HGSC) of ovarian, tubal and peritoneal origin. Risk-reducing salpingo-oophorectomy (RRSO) is usually recommended to BRCA1 or BRCA2 carriers after completion of childbearing. Despite prior systematic reviews and meta-analyses on the role of RRSO in reducing the mortality and incidence of breast, HGSC and other cancers, RRSO is still an area of debate and it is unclear whether RRSO differs in effectiveness by type of mutation carried. OBJECTIVES To assess the benefits and harms of RRSO in women with BRCA1 or BRCA2 mutations. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 7) in The Cochrane Library, MEDLINE Ovid, Embase Ovid and trial registries, with no language restrictions up to July 2017. We handsearched abstracts of scientific meetings and other relevant publications. SELECTION CRITERIA We included non-randomised trials (NRS), prospective and retrospective cohort studies, and case series that used statistical adjustment for baseline case mix using multivariable analyses comparing RRSO versus no RRSO in women without a previous or coexisting breast, ovarian or fallopian tube malignancy, in women with or without hysterectomy, and in women with a risk-reducing mastectomy (RRM) before, with or after RRSO. DATA COLLECTION AND ANALYSIS We extracted data and performed meta-analyses of hazard ratios (HR) for time-to-event variables and risk ratios (RR) for dichotomous outcomes, with 95% confidence intervals (CI). To assess bias in the studies, we used the ROBINS-I 'Risk of bias' assessment tool. We quantified inconsistency between studies by estimating the I2 statistic. We used random-effects models to calculate pooled effect estimates. MAIN RESULTS We included 10 cohort studies, comprising 8087 participants (2936 (36%) surgical participants and 5151 (64%) control participants who were BRCA1 or BRCA2 mutation carriers. All the studies compared RRSO with or without RRM versus no RRSO (surveillance). The certainty of evidence by GRADE assessment was very low due to serious risk of bias. Nine studies, including 7927 women, were included in the meta-analyses. The median follow-up period ranged from 0.5 to 27.4 years. MAIN OUTCOMES overall survival was longer with RRSO compared with no RRSO (HR 0.32, 95% CI 0.19 to 0.54; P < 0.001; 3 studies, 2548 women; very low-certainty evidence). HGSC cancer mortality (HR 0.06, 95% CI 0.02 to 0.17; I² = 69%; P < 0.0001; 3 studies, 2534 women; very low-certainty evidence) and breast cancer mortality (HR 0.58, 95% CI 0.39 to 0.88; I² = 65%; P = 0.009; 7 studies, 7198 women; very low-certainty evidence) were lower with RRSO compared with no RRSO. None of the studies reported bone fracture incidence. There was a difference in favour of RRSO compared with no RRSO in terms of ovarian cancer risk perception quality of life (MD 15.40, 95% CI 8.76 to 22.04; P < 0.00001; 1 study; very low-certainty evidence). None of the studies reported adverse events.Subgroup analyses for main outcomes: meta-analysis showed an increase in overall survival among women who had RRSO versus women without RRSO who were BRCA1 mutation carriers (HR 0.30, 95% CI 0.17 to 0.52; P < 0001; I² = 23%; 3 studies; very low-certainty evidence) and BRCA2 mutation carriers (HR 0.44, 95% CI 0.23 to 0.85; P = 0.01; I² = 0%; 2 studies; very low-certainty evidence). The meta-analysis showed a decrease in HGSC cancer mortality among women with RRSO versus no RRSO who were BRCA1 mutation carriers (HR 0.10, 95% CI 0.02 to 0.41; I² = 54%; P = 0.001; 2 studies; very low-certainty evidence), but uncertain for BRCA2 mutation carriers due to low frequency of HGSC cancer deaths in BRCA2 mutation carriers. There was a decrease in breast cancer mortality among women with RRSO versus no RRSO who were BRCA1 mutation carriers (HR 0.45, 95% CI 0.30 to 0.67; I² = 0%; P < 0.0001; 4 studies; very low-certainty evidence), but not for BRCA2 mutation carriers (HR 0.88, 95% CI 0.42 to 1.87; I² = 63%; P = 0.75; 3 studies; very low-certainty evidence). One study showed a difference in favour of RRSO versus no RRSO in improving quality of life for ovarian cancer risk perception in women who were BRCA1 mutation carriers (MD 10.70, 95% CI 2.45 to 18.95; P = 0.01; 98 women; very low-certainty evidence) and BRCA2 mutation carriers (MD 13.00, 95% CI 3.59 to 22.41; P = 0.007; very low-certainty evidence). Data from one study showed a difference in favour of RRSO and RRM versus no RRSO in increasing overall survival (HR 0.14, 95% CI 0.02 to 0.98; P = 0.0001; I² = 0%; low-certainty evidence), but no difference for breast cancer mortality (HR 0.78, 95% CI 0.51 to 1.19; P = 0.25; very low-certainty evidence). The risk estimates for breast cancer mortality according to age at RRSO (50 years of age or less versus more than 50 years) was not protective and did not differ for BRCA1 (HR 0.85, 95% CI 0.64 to 1.11; I² = 16%; P = 0.23; very low-certainty evidence) and BRCA2 carriers (HR 0.88, 95% CI 0.42 to 1.87; I² = 63%; P = 0.75; very low-certainty evidence). AUTHORS' CONCLUSIONS There is very low-certainty evidence that RRSO may increase overall survival and lower HGSC and breast cancer mortality for BRCA1 and BRCA2 carriers. Very low-certainty evidence suggests that RRSO reduces the risk of death from HGSC and breast cancer in women with BRCA1 mutations. Evidence for the effect of RRSO on HGSC and breast cancer in BRCA2 carriers was very uncertain due to low numbers. These results should be interpreted with caution due to questionable study designs, risk of bias profiles, and very low-certainty evidence. We cannot draw any conclusions regarding bone fracture incidence, quality of life, or severe adverse events for RRSO, or for effects of RRSO based on type and age at risk-reducing surgery. Further research on these outcomes is warranted to explore differential effects for BRCA1 or BRCA2 mutations.
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Affiliation(s)
- George U Eleje
- Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi CampusEffective Care Research Unit, Department of Obstetrics and GynaecologyPMB 5001, NnewiNigeria
| | - Ahizechukwu C Eke
- Johns Hopkins University School of MedicineDivision of Maternal Fetal Medicine, Department of Gynecology and Obstetrics600 N Wolfe StreetPhipps 228BaltimoreUSA21287‐1228
| | - Ifeanyichukwu U Ezebialu
- Faculty of Clinical medicine, College of Medicine, Anambra State University AmakuDepartment of Obstetrics and GynaecologyAwkaNigeria
| | - Joseph I Ikechebelu
- Nnamdi Azikiwe University Teaching HospitalDepartment of Obstetrics/GynaecologyNnewiNigeria
| | - Emmanuel O Ugwu
- University of Nigeria Enugu Campus/University of Nigeria Teaching Hospital Ituko‐OzallaObstetrics and GynaecologyEnuguNigeria400001
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Risk-reducing Surgery in Women at Low Lifetime Risk of Developing Ovarian Carcinoma: Opportunistic Salpingectomy. Clin Obstet Gynecol 2018; 60:758-770. [PMID: 28957952 DOI: 10.1097/grf.0000000000000315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lack of success in ovarian cancer control through screening or advances in treatment in the general population has prompted exploration in new avenues of prevention. "Opportunistic" salpingectomy describes a surgical procedure or risk-reducing intent in women at low-risk/general population risk for developing ovarian cancer who are undergoing pelvic/abdominal surgery for other indications. This chapter reviews the uptake, safety, and anticipated impact of this prevention initiative.
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Arts-de Jong M, DeJong CAJ, Hermens RP, Kissane DW, Massuger LM, Hoogerbrugge N, Prins JB, deHullu JA. High demoralization in a minority of oophorectomized BRCA1/2 mutation carriers influences quality of life. J Psychosom Obstet Gynaecol 2018; 39:96-104. [PMID: 28279121 DOI: 10.1080/0167482x.2017.1296429] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Demoralization is a relatively neglected issue in which low morale and poor coping result from a stressor such as familial cancer risk. Female BRCA1/2 mutation carriers are highly susceptible for developing breast and ovarian cancer. The aim of this study was to evaluate demoralization in oophorectomized BRCA1/2 mutation carriers and its relation to quality of life. METHODS This cross-sectional study examined 288 oophorectomized BRCA1/2 mutation carriers using the following standardized self-report measures: Demoralization Scale, EORTC Quality of Life Questionnaire-C30, State-Trait Anxiety Inventory and the Cancer Worry Scale. RESULTS The mean score on the Demoralization Scale was 17.8 (SD 14.0). A clinically significant level of demoralization, defined as a score ≥30, was found in 45 BRCA1/2 mutation carriers (16%). Being highly demoralized was associated with a significantly lower quality of life, and higher levels of physical problems, anxiety and cancer worries. No demographic or clinical factors could predict higher levels of demoralization. CONCLUSIONS Our findings established that a clear proportion of oophorectomized BRCA1/2 mutation carriers experience demoralization impacting on their well-being. Further research is needed to explore the natural trajectory of demoralization and the resultant need for support in these women.
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Affiliation(s)
- Marieke Arts-de Jong
- a Department of Obstetrics and Gynaecology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Cor A J DeJong
- b Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University Nijmegen , Nijmegen , The Netherlands
| | - Rosella P Hermens
- c Scientific Institute for Quality of Health Care, Radboud University Medical Center , Nijmegen , The Netherlands
| | - David W Kissane
- d Department of Psychiatry, School of Clinical Sciences at Monash Health , Monash University , Clayton , Victoria , Australia
| | - Leon M Massuger
- a Department of Obstetrics and Gynaecology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Nicoline Hoogerbrugge
- e Department of Human Genetics , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Judith B Prins
- f Department of Medical Psychology , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Joanne A deHullu
- a Department of Obstetrics and Gynaecology , Radboud University Medical Center , Nijmegen , The Netherlands
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Perspectives and decision-making about menopausal therapies in women who had bilateral oophorectomy. Menopause 2018; 25:795-802. [PMID: 29381661 DOI: 10.1097/gme.0000000000001069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to explore the process of decision-making about menopausal treatments in women who have had surgical menopause as a result of bilateral oophorectomy (≤50 y). METHODS We used a descriptive qualitative research design. Women who had a surgical menopause were purposefully selected from the Edmonton Menopause Clinics. Focus groups were held, each with six to nine participants. All sessions were audio-recorded and transcribed verbatim. Data were analyzed using qualitative content analysis. RESULTS We conducted five focus groups from June 30 to July 21, 2016 (N = 37). One-third of the women had the surgery within the last 5 years. Almost all women had a concurrent hysterectomy (97%) and were current users of hormone therapy (70%). Four main themes identified were "perceptions of surgical menopause," "perceptions of received support," "being my own advocate," and "concept of adequate support." Women shared that the experience was worse than their expectations and did not believe they were given adequate support to prepare them to make therapy decisions. Women had to "be their own advocates" and seek support from within the healthcare system and outside to cope with their health issues. To make an informed decision about treatments postsurgery, women expressed a need to learn more about the symptoms of surgical menopause, treatment options, resources, avenues for support, and stories of similar experiences, preferably before the surgery. CONCLUSIONS We identified several modifiable deterrents to decision-making in early surgical menopause which can help inform the development of a patient decision aid for this context.
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Heramb C, Wangensteen T, Grindedal EM, Ariansen SL, Lothe S, Heimdal KR, Mæhle L. BRCA1 and BRCA2 mutation spectrum - an update on mutation distribution in a large cancer genetics clinic in Norway. Hered Cancer Clin Pract 2018; 16:3. [PMID: 29339979 PMCID: PMC5761139 DOI: 10.1186/s13053-017-0085-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/28/2017] [Indexed: 12/13/2022] Open
Abstract
Background Founder mutations in the two breast cancer genes, BRCA1 and BRCA2, have been described in many populations, among these are Ashkenazi-Jewish, Polish, Norwegian and Icelandic. Founder mutation testing in patients with relevant ancestry has been a cost-efficient approach in such populations. Four Norwegian BRCA1 founder mutations were defined by haplotyping in 2001, and accounted for 68% of BRCA1 mutation carriers at the time. After 15 more years of genetic testing, updated knowledge on the mutation spectrum of both BRCA1 and BRCA2 in Norway is needed. In this study, we aim at describing the mutation spectrum and frequencies in the BRCA1/2 carrier population of the largest clinic of hereditary cancer in Norway. Methods A total of 2430 BRCA1 carriers from 669 different families, and 1092 BRCA2 carriers from 312 different families were included in a quality of care study. All variants were evaluated regarding pathogenicity following ACMG/ENIGMA criteria. The variants were assessed in AlaMut and supplementary databases to determine whether they were known to be founder mutations in other populations. Results There were 120 different BRCA1 and 87 different BRCA2 variants among the mutation carriers. Forty-six per cent of the registered BRCA1/2 families (454/981) had a previously reported Norwegian founder mutation. The majority of BRCA1/2 mutations (71%) were rare, each found in only one or two families. Fifteen per cent of BRCA1 families and 25% of BRCA2 families had one of these rare variants. The four well-known Norwegian BRCA1 founder mutations previously confirmed through haplotyping were still the four most frequent mutations in BRCA1 carriers, but the proportion of BRCA1 mutation carriers accounted for by these mutations had fallen from 68 to 52%, and hence the founder effect was weaker than previously described. Conclusions The spectrum of BRCA1 and BRCA2 mutations in the carrier population at Norway’s largest cancer genetics clinic is diverse, and with a weaker founder effect than previously described. As a consequence, retesting the families that previously have been tested with specific tests/founder mutation tests should be a prioritised strategy to find more mutation positive families and possibly prevent cancer in healthy relatives.
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Affiliation(s)
- Cecilie Heramb
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway.,Norwegian National Advisory Unit on Women's Health, Oslo University Hospital, Oslo, Norway
| | | | | | | | - Sheba Lothe
- Department of Medical Genetics, MSc Oslo University Hospital, Oslo, Norway
| | | | - Lovise Mæhle
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
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Jeffers L, Reid J, Fitzsimons D, Morrison PJ, Dempster M. Interventions to improve psychosocial well-being in female BRCA
-mutation carriers following risk-reducing surgery. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Lisa Jeffers
- Regional Medical Genetics Centre; Medical Genetics; Belfast Health and Social Care Trust Lisburn Road Belfast UK BT9 7AB
| | - Joanne Reid
- Queen's University Belfast; School of Nursing and Midwifery; 10 Malone Road Belfast UK BT9 5BN
| | - Donna Fitzsimons
- Queen's University Belfast; School of Nursing and Midwifery; 10 Malone Road Belfast UK BT9 5BN
| | - Patrick J Morrison
- Regional Medical Genetics Centre; Medical Genetics; Belfast Health and Social Care Trust Lisburn Road Belfast UK BT9 7AB
- The Queen's University Belfast; Centre for Cancer Research and Cell Biology; 97 Lisburn Road Belfast UK BT9 7AE
| | - Martin Dempster
- Queen's University Belfast; School of Psychology; University Road Belfast Northern Ireland UK BT7 1NN
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Hickey M, Trainer A, Braat S, Davey MA, Krejany E, Wark J. What Happens After Menopause? (WHAM): protocol for a prospective, multicentre, age-matched cohort trial of risk-reducing bilateral salpingo-oophorectomy in high-risk premenopausal women. BMJ Open 2017; 7:e018758. [PMID: 29138210 PMCID: PMC5695307 DOI: 10.1136/bmjopen-2017-018758] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Women at high inherited risk of ovarian cancer are advised to undergo risk-reducing bilateral salpingo-oophorectomy (RRBSO) at age 40-45 years or when their families are complete. Most women are premenopausal at this age, so RRBSO will induce surgical menopause. Despite the clear benefits of RRBSO for cancer risk reduction, much less is known about the impact on non-cancer outcomes that contribute to health and well-being and inform surveillance and management strategies. METHODS AND ANALYSIS This will be a multicentre, prospective cohort study of 105 premenopausal high-risk women undergoing RRBSO and an age-matched comparison group of 105 premenopausal women not planning oophorectomy or pregnancy in the next 2 years. The aim of this study is to measure the impact of RRBSO on sexual function (primary outcome) at 24 months in high-risk premenopausal women compared with the comparison group. Secondary outcomes include menopausal symptoms and menopause-related quality of life, mood, sleep quality, markers of cardiovascular disease and pre-diabetes, bone density and markers of bone turnover, and the impact of hormone replacement therapy use on these outcomes. Data analysis methods will include logistic and linear regression using general estimating equations accounting for the repeated outcome measurements within each participant. ETHICS AND DISSEMINATION The study has been approved by institutional ethics committees at each participating centre. Findings will be disseminated through peer-reviewed publications and conference presentations, and national and international networks of centres managing high-risk women, and will inform national and international clinical guidelines. TRIAL REGISTRATION NUMBER The pre-results protocol for this trial is registered with the Australian New Zealand Clinical Trials Registry (anzctr.org.au; registration no: ACTRN12615000082505).
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Affiliation(s)
- Martha Hickey
- Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Alison Trainer
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sabine Braat
- Melbourne Clinical and Translational Sciences (MCATS), Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Efrosinia Krejany
- Gynaecology Research Centre, The Royal Women’s Hospital, Parkville, Victoria, Australia
| | - John Wark
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Bone and Mineral Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Abstract
Hereditary breast and ovarian cancer syndrome is an inherited cancer-susceptibility syndrome characterized by multiple family members with breast cancer, ovarian cancer, or both. Based on the contemporary understanding of the origins and management of ovarian cancer and for simplicity in this document, ovarian cancer also refers to fallopian tube cancer and primary peritoneal cancer. Clinical genetic testing for gene mutations allows more precise identification of those women who are at an increased risk of inherited breast cancer and ovarian cancer. For these individuals, screening and prevention strategies can be instituted to reduce their risks. Obstetrician-gynecologists play an important role in the identification and management of women with hereditary breast and ovarian cancer syndrome. If an obstetrician-gynecologist or other gynecologic care provider does not have the necessary knowledge or expertise in cancer genetics to counsel a patient appropriately, referral to a genetic counselor, gynecologic or medical oncologist, or other genetics specialist should be considered (1). More genes are being discovered that impart varying risks of breast cancer, ovarian cancer, and other types of cancer, and new technologies are being developed for genetic testing. This Practice Bulletin focuses on the primary genetic mutations associated with hereditary breast and ovarian cancer syndrome, BRCA1 and BRCA2, but also will briefly discuss some of the other genes that have been implicated.
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Hormone replacement therapy after risk-reducing salpingo-oophorectomy minimises endocrine and sexual problems: A prospective study. Eur J Cancer 2017; 84:159-167. [PMID: 28818705 DOI: 10.1016/j.ejca.2017.07.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/12/2017] [Accepted: 07/12/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND There has been some doubts raised in earlier studies about the efficacy of hormone replacement therapy (HRT) in reducing endocrine and sexual problems in women who have undergone a risk-reducing salpingo-oophorectomy (RRSO). METHODS In this prospective, observational study, we recruited 178 premenopausal women with a high risk for ovarian cancer. Fifty-seven women opted for RRSO and 121 for gynaecological screening (GS). Women completed questionnaires before surgery (T1) and 3 (T2) and 9 (T3) months post surgery, or at equivalent time points for the GS-group. Menopausal symptoms were assessed with the Functional Assessment of Cancer Therapy-Endocrine Subscale (FACT-ES) and sexual functioning with the Sexual Activity Questionnaire (SAQ). Groups were compared using repeated measures mixed effect models for continuous variables, and generalised estimating equations for longitudinal ordered categorical data. RESULTS Twenty-seven women who underwent RRSO used HRT after surgery (HRT-users) and 30 did not (HRT-non-users). There were no significant group differences at baseline on the outcome variables. Compared to the HRT-users, the HRT-non-users exhibited a significant increase in overall endocrine symptoms (p = 0.001, effect size (ES) = -0.40 and p < 0.001, ES = -0.59 at T1 and T2, respectively), and in sexual discomfort (p < 0.001, ES = 0.74 and p < 0.001, ES = 1.17). The effect size provides an indication of the magnitude of the observed group differences. An effect size of 0.50 or greater is generally considered to be clinically relevant. No significant differences over time were observed between the HRT-users and the GS-group on any of the outcomes. CONCLUSION Our results suggest that HRT use in the first year after RRSO has beneficial effects in terms of minimising endocrine symptoms and sexual symptoms in premenopausal women who have undergone RRSO.
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Suh DH, Kim M, Kim K, Kim HJ, Lee KH, Kim JW. Major clinical research advances in gynecologic cancer in 2016: 10-year special edition. J Gynecol Oncol 2017; 28:e45. [PMID: 28382802 PMCID: PMC5391398 DOI: 10.3802/jgo.2017.28.e45] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 03/20/2017] [Accepted: 03/20/2017] [Indexed: 12/11/2022] Open
Abstract
In 2016, 13 topics were selected as major research advances in gynecologic oncology. For ovarian cancer, study results supporting previous ones regarding surgical preventive strategies were reported. There were several targeted agents that showed comparable responses in phase III trials, including niraparib, cediranib, and nintedanib. On the contrary to our expectations, dose-dense weekly chemotherapy regimen failed to prove superior survival outcomes compared with conventional triweekly regimen. Single-agent non-platinum treatment to prolong platinum-free-interval in patients with recurrent, partially platinum-sensitive ovarian cancer did not improve and even worsened overall survival (OS). For cervical cancer, we reviewed robust evidences of larger-scaled population-based study and cost-effectiveness of nonavalent vaccine for expanding human papillomavirus (HPV) vaccine coverage. Standard of care treatment of locally advanced cervical cancer (LACC) was briefly reviewed. For uterine corpus cancer, new findings about appropriate surgical wait time from diagnosis to surgery were reported. Advantages of minimally invasive surgery over conventional laparotomy were reconfirmed. There were 5 new gene regions that increase the risk of developing endometrial cancer. Regarding radiation therapy, Post-Operative Radiation Therapy in Endometrial Cancer (PORTEC)-3 quality of life (QOL) data were released and higher local control rate of image-guided adaptive brachytherapy was reported in LACC. In addition, 4 general oncology topics followed: chemotherapy at the end-of-life, immunotherapy with reengineering T-cells, actualization of precision medicine, and artificial intelligence (AI) to make personalized cancer therapy real. For breast cancer, adaptively randomized trials, extending aromatase inhibitor therapy, and ribociclib and palbociclib were introduced.
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Affiliation(s)
- Dong Hoon Suh
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Miseon Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kidong Kim
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jae Weon Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
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Mai PL, Piedmonte M, Han PK, Moser RP, Walker JL, Rodriguez G, Boggess J, Rutherford TJ, Zivanovic O, Cohn DE, Thigpen JT, Wenham RM, Friedlander ML, Hamilton CA, Bakkum-Gamez J, Olawaiye AB, Hensley ML, Greene MH, Huang HQ, Wenzel L. Factors associated with deciding between risk-reducing salpingo-oophorectomy and ovarian cancer screening among high-risk women enrolled in GOG-0199: An NRG Oncology/Gynecologic Oncology Group study. Gynecol Oncol 2017; 145:122-129. [PMID: 28190649 PMCID: PMC5359045 DOI: 10.1016/j.ygyno.2017.02.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 02/03/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Women at increased genetic risk of ovarian cancer (OC) are recommended to have risk-reducing salpingo-oophorectomy (RRSO) after completion of reproductive planning. Effective screening has not been established, and novel screening modalities are being evaluated. METHODS Participants chose either RRSO or a novel OC screening regimen (OCS) as their risk management option, and provided demographic and other data on BRCA mutation status, cancer worry, perceived intervention risks/benefits, perceived cancer risk, and quality-of-life at enrollment. We performed univariate and multivariate analyses to evaluate factors influencing decision between RRSO and OCS. RESULTS Of 2287 participants enrolled, 904 (40%) chose RRSO and 1383 (60%) chose OCS. Compared with participants choosing OCS, participants choosing RRSO were older (p<0.0001), more likely to carry deleterious BRCA1/2 mutations (p<0.0001), perceive RRSO as effective, be more concerned about surgical harms and OCS limitations, and report higher perceived OC risk and OC-related worry. OCS participants were more likely to perceive screening as effective, be more concerned about menopausal symptoms, infertility, and loss of femininity, and report better overall quality-of-life. Twenty-four percent of participants believed they would definitely develop OC, and half estimated their lifetime OC risk as >50%, both higher than objective risk estimates. CONCLUSIONS Cancer worry, BRCA1/2 mutation status, and perceived intervention-related risks and benefits were associated with choosing between RRSO and OCS. Efforts to promote individualized, evidence-based, shared medical decision-making among high-risk women facing management choices should focus on conveying accurate OC risk estimates, clarifying the current understanding of intervention-related benefits and limitations, and addressing OC worry.
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Affiliation(s)
- Phuong L Mai
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852-9772, United States.
| | - Marion Piedmonte
- NRG Oncology, Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States.
| | - Paul K Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME 04101, United States.
| | - Richard P Moser
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20850, United States.
| | - Joan L Walker
- Stephenson Cancer Center, Department of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States.
| | - Gustavo Rodriguez
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL 60201, United States.
| | - John Boggess
- Gynecologic Oncology Program, University of North Carolina, Chapel Hill, NC 27514, United States.
| | - Thomas J Rutherford
- Gynecologic Oncology, Yale University School of Medicine, New Haven, CT 06520, United States.
| | - Oliver Zivanovic
- Innovative Surgical Technology, Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10022, United States.
| | - David E Cohn
- Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH, United States.
| | - J Tate Thigpen
- Division of Medical Oncology, University of Mississippi Medical Center, Jackson, MS 39216, United States.
| | - Robert M Wenham
- Department of Gynecologic Oncology, Program of Chemical Biology and Molecular Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States.
| | | | - Chad A Hamilton
- Gynecologic Cancer Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States.
| | - Jamie Bakkum-Gamez
- Department of GYN Surgery, Mayo Clinic, Rochester, MN 55905, United States.
| | - Alexander B Olawaiye
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA 15143, United States.
| | - Martee L Hensley
- Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, United States.
| | - Mark H Greene
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852-9772, United States.
| | - Helen Q Huang
- NRG Oncology, Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States.
| | - Lari Wenzel
- Center for Health Policy Research, University of California, Irvine, Irvine, CA 92697, United States.
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Vermeulen RFM, Beurden MV, Korse CM, Kenter GG. Impact of risk-reducing salpingo-oophorectomy in premenopausal women. Climacteric 2017; 20:212-221. [PMID: 28509627 DOI: 10.1080/13697137.2017.1285879] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To describe implications of premenopausal risk-reducing salpingo-oophorectomy (RRSO) on quality of life, endocrine symptoms, sexual function, osteoporosis, cardiovascular health, metabolic syndrome, cognitive impairment and safety of hormone replacement therapy. METHODS We searched the following electronic databases: The Cochrane Library, EMBASE, PsycInfo, and MEDLINE. We selected controlled and uncontrolled trials of premenopausal women undergoing RRSO. Two authors independently assessed studies for inclusion. Reference lists of included reports were searched manually for additional studies. RESULTS Surgical menopause leads to more menopausal complaints and sexual dysfunction than natural menopause. Overall quality of life is not affected by surgery. In the limited literature, there is no evidence that RRSO leads to more osteopenia in comparison with natural menopause at a young age. Cohort studies show a slight impaired cardiovascular health. Cognitive function decreases later in life in premenopausal oophorectomized women. Short-term hormone replacement therapy seems to decline postmenopausal complaints and does not seem to increase the risk for breast carcinoma in mutation carriers without a personal history of breast carcinoma. CONCLUSIONS The conclusions of this systematic review are limited by the absence of randomized, controlled trials. There is growing evidence from observational studies that RRSO may impact negatively on all-cause non-survival endpoints.
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Affiliation(s)
- R F M Vermeulen
- a Department of Gynecology , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - M van Beurden
- a Department of Gynecology , The Netherlands Cancer Institute , Amsterdam , The Netherlands.,c Center for Gynecologic Oncology Amsterdam , Amsterdam , The Netherlands
| | - C M Korse
- b Department of Clinical Chemistry , The Netherlands Cancer Institute , Amsterdam , The Netherlands
| | - G G Kenter
- a Department of Gynecology , The Netherlands Cancer Institute , Amsterdam , The Netherlands.,c Center for Gynecologic Oncology Amsterdam , Amsterdam , The Netherlands
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Young JL, Werner-Lin A, Mueller R, Hoskins L, Epstein N, Greene MH. Longitudinal cancer risk management trajectories of BRCA1/2 mutation-positive reproductive-age women. J Psychosoc Oncol 2017; 35:393-408. [PMID: 28332940 DOI: 10.1080/07347332.2017.1292574] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Young women with BRCA1/2 mutations face difficult health-care decisions regarding family formation, fertility, breastfeeding, and whether/when to undergo cancer risk-reducing surgery. This longitudinal qualitative study investigated these life choices during the reproductive years. We conducted two semistructured interviews over three years with 12 reproductive-age BRCA1/2-positive women. Researchers coded transcripts to examine the evolution of risk perceptions, risk management, and family planning decisions. To cope with the conflict between cancer risk reduction versus plans for pregnancy, breastfeeding, and child rearing, participants deliberately prioritized either risk reducing surgery or family formation goals. Implications for mutation carriers and health-care providers are outlined.
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Affiliation(s)
- Jennifer Louise Young
- a Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch , National Cancer Institute , Bethesda , MD , USA.,b Department of Family Science , University of Maryland at College Park , College Park , MD , USA
| | - Allison Werner-Lin
- c School of Social Policy and Practice , University of Pennsylvania , Philadelphia , PA , USA
| | - Rebecca Mueller
- d School of Arts and Sciences , University of Pennsylvania , Philadelphia , PA , USA
| | - Lindsey Hoskins
- a Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch , National Cancer Institute , Bethesda , MD , USA
| | - Norman Epstein
- b Department of Family Science , University of Maryland at College Park , College Park , MD , USA
| | - Mark H Greene
- a Division of Cancer Epidemiology and Genetics, Clinical Genetics Branch , National Cancer Institute , Bethesda , MD , USA
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Randall LM, Pothuri B. The genetic prediction of risk for gynecologic cancers. Gynecol Oncol 2016; 141:10-6. [PMID: 27016223 DOI: 10.1016/j.ygyno.2016.03.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 03/06/2016] [Accepted: 03/06/2016] [Indexed: 12/21/2022]
Abstract
Salient to the intent of personalized medicine, hereditary cancer syndromes present significant opportunities in the treatment and prevention of some gynecologic cancers. Mutations in BRCA1, BRCA2, and DNA mismatch repair genes: MLH1, MSH2, MSH6, and PMS2 are important causal agents in hereditary breast and ovarian cancer (HBOC) and Lynch syndromes. Though they only account for an estimated 10-18% of ovarian, tubal, peritoneal, and endometrial cancer cases, inherited cancers are imminently preventable if mutation carriers are identified in a timely manner. Population level screening is currently impractical due to low prevalence of disease, cost of testing, and ethical issues associated with testing, so diagnosis of these mutations is limited. Being affected by one of the heritable gynecologic malignancies is a logical entry point into the genetic counseling and testing pipeline for the patient and her family members. Thus, gynecologic cancer providers are uniquely positioned to diagnose germline mutations that can inform prognosis and treatment for their patients in addition to enabling prevention for patients' cancer-unaffected blood relatives, or "previvors". The purpose of this review is to describe our current perspective on testing for and implications of heritable cancer syndromes in the women with ovarian, tubal, peritoneal, and endometrial cancers.
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Affiliation(s)
- Leslie M Randall
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine, 101 The City Dr. South, Bldg 56, Room 262, Orange, CA 92868.
| | - Bhavana Pothuri
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, NYU Langone Medical Center, 240 E. 38th St., 19th floor, New York, NY 10016.
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Obermair A, Youlden D, Baade P, Janda M. Do breast cancer survivors benefit from prophylactic removal of uterus and ovaries? A population-based data linkage replication study. Asia Pac J Clin Oncol 2016; 13:68-78. [PMID: 27230709 DOI: 10.1111/ajco.12508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/11/2015] [Accepted: 01/13/2016] [Indexed: 11/27/2022]
Abstract
AIM Our previous population-based research found prophylactic surgery (hysterectomy and bilateral salpingo-oophorectomy [BSO]) halved the mortality risk for premenopausal breast cancer patients. Here we aim to replicate findings in a Western Australia dataset. METHOD Data from the Western Australia Cancer Registry of 15 395 women 20-79 years diagnosed with primary breast cancer (1997-2011) was categorized into four groups: neither hysterectomy nor BSO, hysterectomy only, BSO only, or hysterectomy + BSO. We fitted flexible parametric breast cancer-specific and overall survival models with 95% confidence intervals (also known as Royston-Parmar models) to assess the impact of prophylactic surgery. RESULTS A total of 12 630 (82.0%) patients had no surgery, 1799 (11.7%) had a hysterectomy only, 337 (2.2%) had BSO only and 629 (4.1%) had both a hysterectomy and BSO. For all-causes mortality, unadjusted 10-year survival was highest for women who had either a hysterectomy + BSO (84.7%) or a hysterectomy only (84.2%). After adjusting for covariates, the survival advantage compared to women without any surgery remained significant for the hysterectomy only group (hazard ratio [HR] = 0.89; 95% confidence interval [CI], 0.81-0.98; P = 0.02). A similar pattern emerged in breast cancer-specific survival with significantly improved survival for women who had a hysterectomy only (HR = 0.83; 95% CI, 0.74-0.94; P = 0.003). However, for non-breast cancer-related survival, having a BSO alone increased risk of death (HR = 1.83; 95% CI, 1.14-2.93; P = 0.01). CONCLUSION We observed significantly improved overall and breast cancer-specific survival among women who had a hysterectomy only, but increased non-breast cancer-related risk after BSO only. Breast cancer patients must weigh up pros and cons of prophylactic surgery.
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Affiliation(s)
- Andreas Obermair
- School of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Danny Youlden
- Cancer Council Queensland, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter Baade
- Cancer Council Queensland, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Monika Janda
- Institute for Health and Biomedical Innovation, School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Fujiwara K, McAlpine JN, Lheureux S, Matsumura N, Oza AM. Paradigm Shift in the Management Strategy for Epithelial Ovarian Cancer. Am Soc Clin Oncol Educ Book 2016; 35:e247-e257. [PMID: 27249730 DOI: 10.1200/edbk_158675] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The hypothesis on the pathogenesis of epithelial ovarian cancer continues to evolve. Although epithelial ovarian cancer had been assumed to arise from the coelomic epithelium of the ovarian surface, it is now becoming clearer that the majority of serous carcinomas arise from epithelium of the distal fallopian tube, whereas clear cell and endometrioid cancers arise from endometriosis. Molecular and genomic characteristics of epithelial ovarian cancer have been extensively investigated. Our understanding of pathogenesis of the various histologic types of ovarian cancer have begun to inform changes to the strategies for management of epithelial ovarian cancer, which represent a paradigm shift not only for treatment but also for prevention, which previously had not been considered achievable. In this article, we will discuss novel attempts at the prevention of high-grade serous ovarian cancer and treatment strategies for two distinct entities in epithelial ovarian cancer: low-grade serous and clear cell ovarian carcinomas, which are relatively rare and resistant to conventional chemotherapy.
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Affiliation(s)
- Keiichi Fujiwara
- From the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan; Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, Canada; Division of Medical Oncology and Hematology, Bras Family Drug Development Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Jessica N McAlpine
- From the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan; Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, Canada; Division of Medical Oncology and Hematology, Bras Family Drug Development Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Stephanie Lheureux
- From the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan; Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, Canada; Division of Medical Oncology and Hematology, Bras Family Drug Development Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Noriomi Matsumura
- From the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan; Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, Canada; Division of Medical Oncology and Hematology, Bras Family Drug Development Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
| | - Amit M Oza
- From the Department of Gynecologic Oncology, Saitama Medical University International Medical Center, Saitama, Japan; Department of Gynecology and Obstetrics, University of British Columbia, Vancouver, Canada; Division of Medical Oncology and Hematology, Bras Family Drug Development Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
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Shigehiro M, Kita M, Takeuchi S, Ashihara Y, Arai M, Okamura H. Study on the psychosocial aspects of risk-reducing salpingo-oophorectomy (RRSO) in BRCA1/2 mutation carriers in Japan: a preliminary report. Jpn J Clin Oncol 2015; 46:254-9. [DOI: 10.1093/jjco/hyv190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/16/2015] [Indexed: 12/20/2022] Open
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A model for estimating ovarian cancer risk: Application for preventive oophorectomy. Gynecol Oncol 2015; 139:242-7. [DOI: 10.1016/j.ygyno.2015.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 12/29/2022]
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Abstract
As the testing criteria for BRCA expand, we are identifying a greater number of young women at significant risk for breast and ovarian cancer. Fortunately, there is strong evidence to support risk reduction from mastectomy and oophorectomy. However, these surgeries come with significant psychological and physical health consequences. For breast cancer, screening with mammogram and magnetic resonance imaging may be a reasonable approach for a woman who does not desire surgery. However, there is no evidence to suggest any efficacy in screening for ovarian cancer, and women electing to not undergo surgery must have a detailed discussion with their physician regarding the risks and benefits of different management strategies. As more women are electing to undergo surgical risk reduction, providers must also be able to counsel and care for these women who will face unique health challenges after surgical menopause at a young age. A review of the current evidence behind management of the BRCA woman follows, with a focus on areas of controversy and current research.
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