Genetic susceptibility testing and prophylactic oophorectomy

Risk factors for ovarian cancer: lesbian and heterosexual women

PURPOSE/OBJECTIVES

To compare the distribution of risk factors for developing ovarian cancer in lesbian and heterosexual women.

DESIGN

Secondary analysis of a retrospective medical record review.

SETTING

Urban health clinic with special outreach to lesbians.

SAMPLE

Typical participant (N = 1,019) was 42.9 years old and white (70%). Most were without health insurance, and 99% were poor (< $15,780 annual income). The majority (58%, n = 586) described themselves as heterosexual; 42% (n = 433) said they were lesbian.

METHODS

Data were collected from medical records and analyzed using analysis of covariance and logistic regression techniques.

MAIN RESEARCH VARIABLES

Ovarian cancer risk factors (parity, exogenous hormone use, smoking, body mass index [BMI], and tubal ligation/hysterectomy).

FINDINGS

Lesbians had a higher BMI; heterosexual women had higher rates of current smoking and a higher incidence of the protective factors of pregnancy, children, miscarriages, abortions, and use of birth control pills.

CONCLUSIONS

The results of this study indicate that lesbians may have an increased risk for developing ovarian cancer. A study designed specifically to explore the risk factors of lesbian and heterosexual women for developing ovarian cancer must be undertaken to confirm these findings.

IMPLICATIONS FOR NURSING PRACTICE

Differences in risk levels may exist for lesbians; therefore, healthcare providers must become comfortable asking questions about sexual orientation and behavior.

Deciding about prophylactic oophorectomy: what is important to women at increased risk of ovarian cancer?

BACKGROUND

Little is known about the factors that women at increased risk of ovarian cancer consider to be important when deciding about prophylactic oophorectomy, surgery to remove the ovaries before they develop cancer.

METHODS

Women who had undergone prophylactic oophorectomy (surgical group; n = 30) were compared with women who remained on the ovarian screening program (nonsurgical group; n = 28) on their importance ratings for a number of relevant decision-making factors.

RESULTS

The most important decision-making factor across all subjects was reducing risk of ovarian cancer, but the single best predictor of group membership was the importance attributed to reducing cancer worry. Women who rated this factor as more important were more likely to be in the surgical group. No women identified the increased risk of heart disease and osteoporosis as issues for consideration.

CONCLUSIONS

The desire to reduce cancer worry is likely to be the most important factor in a woman's decision to proceed to prophylactic oophorectomy. In view of the current imprecision in risk estimates given to women considering this option, cancer worry may override a more rational consideration of the costs and benefits of surgery.