In a prospective, multicenter, nonrandomized patient-preference trial published in JAMA Network Open, interval salpingectomy with delayed oophorectomy (ISDO) was associated with less impairment in sexual function than risk-reducing salpingo-oophorectomy (RRSO) among premenopausal women at high risk for ovarian cancer. Among those who underwent RRSO, however, hormone replacement therapy mitigated menopausal symptoms and prevented declines in sexual function, Lu et al reported.
“RRSO is an effective option to prevent ovarian cancer in high-risk individuals, but adverse effects from premature menopause are a barrier to uptake,” the investigators explained. “[This trial] addresses an important barrier to surgical prevention….”
Study Details
This analysis included participants from the Women Choosing Surgical Prevention trial with a pathogenic or likely pathogenic germline variant conferring an increased risk for ovarian cancer. A total of 426 women were enrolled at nine U.S. centers between June 2, 2016, and October 28, 2020. Participants chose to undergo ISDO or RRSO and were followed for 24 months.
The final analytic sample comprised 334 women (mean age at consent = 39.2 years) who underwent RRSO (n = 165) or ISDO (n = 169) and completed follow-up questionnaires at 6 months.
Changes in sexual function and menopausal symptoms were assessed at 6, 12, and 24 months relative to baseline. Inverse probability weighting was used to balance covariates between groups. The analysis was performed on November 13, 2024.
Key Findings
Clinically meaningful worsening of sexual function was found to be more common after RRSO than ISDO at 6 months (33.1% [39 of 118] vs 16.8% [17 of 101]; odds ratio [OR] = 2.00, 95% confidence interval [CI] = 1.20–3.35) and 12 months (39.2% [38 of 97] vs 18.3% [17 of 93]; OR = 1.69, 95% CI = 1.09–2.63), but the difference was no longer significant at 24 months.
Among women who underwent RRSO and received hormone replacement therapy, total sexual function scores and menopausal symptoms did not appear to worsen significantly from baseline.
The investigators reported no interval ovarian cancers.
“These finding suggest that ISDO may be less likely to impair sexual function than RRSO,” the investigators concluded.
They continued, “For ISDO to be considered a standard-of-care prevention option for high-risk individuals, data supporting its efficacy in preventing ovarian cancer will be critical. The finding of a measurable and clinically significant better outcome in terms of sexual function for patients undergoing ISDO provides important justification for larger trials that will determine safety and efficacy.”
Barbara M. Norquist, MD, of the University of Washington, Seattle, is the corresponding author of the article in JAMA Network Open.
Disclosure: The study was funded by Stand Up To Cancer as part of the Ovarian Cancer Dream Team. For full disclosures of the study authors, visit jamanetwork.com.
