A study published by Gaba et al in BJOG: An International Journal of Obstetrics and Gynaecology has found that risk‐reducing early salpingectomy and delayed oophorectomy is highly acceptable among premenopausal women at increased risk for developing ovarian cancer—particularly among patients concerned about sexual dysfunction.
For women at high risk of ovarian cancer, the standard preventive practice is to offer removal of both the fallopian tubes and ovaries, but this surgery induces menopause. Early menopause is associated with side effects like increased risk of heart disease, osteoporosis, neurocognitive decline, and sexual dysfunction. Therefore, some women at high risk of developing ovarian cancer delay surgery until after they reach menopause; during this period, they remain at much higher risk of ovarian cancer.
A proposed alternative is a two-step surgical protocol, which delays the induced menopause caused by the removal of the ovaries. In this protocol, the fallopian tubes are removed as an initial step to offer some risk reduction, and ovary removal is delayed until a later stage when women have reached menopause. This procedure provides some ovarian cancer risk reduction while avoiding detrimental consequences of premature surgically induced menopause.
Study Methods and Attitudes Around Surgery
In the multicenter, United Kingdom–based study, researchers examined the acceptability of risk‐reducing early salpingectomy and delayed oophorectomy. The 638 study participants were all at increased risk of ovarian cancer; 346 had undergone standard risk-reducing surgery and 337 had not.
Among those who had undergone standard preventive surgery, 9.4% of premenopausal and 1.2% of postmenopausal women regretted their decision. Of premenopausal women who had not undergone standard surgery, 69% found it acceptable to participate in a research study offering the proposed new surgical option. Thirty-eight percent of women who had undergone standard surgery would have potentially (in hindsight) opted for the new two-step operation. The new two-step surgical protocol was particularly acceptable to women concerned about the sexual dysfunction side effects of ovary removal.
The hormone replacement therapy (HRT) uptake rate in premenopausal individuals without breast cancer was 74.1%. HRT use did not significantly affect satisfaction/regret levels but did reduce symptoms of vaginal dryness.
Lead researcher Ranjit Manchanda, MD, MRCOG, PhD, of Queen Mary’s Wolfson Institute of Preventive Medicine and Barts Health NHS Trust, said, “Undergoing an operation to prevent ovarian cancer can be a complex decision-making process. Although removal of tubes and ovaries prevents ovarian cancer, it can lead to early surgical menopause, which has significant detrimental consequences on long-term health. A number of women opt to delay or decline preventive surgery as a result. The new two-step operation offers additional options for women (who may have not undergone surgical prevention) to reduce their ovarian cancer risk while avoiding the negative impact of early menopause. Our study shows a large proportion of eligible women wish to consider this. UK-based women who wish to do so now have the option of joining the PROTECTOR study.”
The study authors concluded, “Data show high risk‐reducing early salpingectomy and delayed oophorectomy acceptability, particularly in women concerned about sexual dysfunction. Although risk‐reducing salpingo‐oophorectomy satisfaction remains high, regret rates are much higher for premenopausal women than for postmenopausal women. HRT use following premenopausal risk‐reducing salpingo‐oophorectomy does not increase satisfaction but does reduce vaginal dryness.”
Disclosure: For full disclosures of the study authors, visit obgyn.onlinelibrary.wiley.com.
