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Surgical decision making in premenopausal BRCA carriers considering risk-reducing early salpingectomy or salpingo-oophorectomy: a qualitative study

by Newton, Claire , Povolotskaya, Natalia , Rosenthal, Adam , Devaja, Omer , Park, Claire , Ragupathy, Kalpana , Crosbie, Emma , McCluggage, W Glenn , Bryson, Gareth , Hutson, Richard , Sharma, Aarti , Balega, Janos , Side, Lucy , Matthews, Nicholas , Hamoodi, Ibraheem , Willett, Mark , Tailor, Anil , Duncan, Tim , Ghaem-Maghami, Sadaf , Rowlands, Gareth , Gaba, Faiza , Saridogan, Ertan , Taylor, Sian , Edey, Katherine , Chandrasekaran, Dhivya , Menon, Usha , Snape, Katie , Rao, Sanjay , Lutchman-Singh, Kerryn , Chalhoub, Tony , Phillips, Andrew , Kaushik, Sonali , Kodiathodi, Suma , Tyson, Charlotte , Seters, Manon van , Arora, Rupali , Chattopadhyay, Supratik , Sundar, Sudha , Abdul, Beena , Fegan, Scott , Peevor, Richard , Brady, Angela , Gurumurthy, Mahalakshmi , Mehra, Gautam , Evans, D Gareth , Hanson, Helen , Sengupta, Partha , Goyal, Shivam , Madhuri, Kavitha Thumuluru , Ganesan, Raji , Mackintosh, Michelle , Borley, Jane , Singh, Naveena , Ahmed, Munaza , Cameron, Iain , Legood, Rosa , Marks, Dalya , Manchanda, Ranjit , Williamson, Karin , Robbani, Sadiyah , Iyer, Rema , Evans, Olivia

in Adult / Breast cancer / Cancer Genetics / Carcinogenesis / Cardiovascular disease / Clinical Decision-Making / Clinics / Cohort Studies / Complications / Decision making / Ethnicity / Fallopian tube / Family medical history / Female / Fertility / Genes, BRCA1 / Genes, BRCA2 / genetics / Gynecological cancer / Gynecology / Heterozygote / Hormone replacement therapy / Humans / Interviews / Literature reviews / Menopause / Middle Aged / Oophorectomy / Ovarian cancer / Ovarian Neoplasms - genetics / Ovarian Neoplasms - prevention & control / Ovariectomy / Premenopause / Prevention / Prophylactic Mastectomy / Prophylactic Surgical Procedures / Qualitative research / Risk Reduction Behavior / Salpingectomy / Salpingo-oophorectomy / Surgery / surgical oncology / White people / Womens health

2022

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Surgical decision making in premenopausal BRCA carriers considering risk-reducing early salpingectomy or salpingo-oophorectomy: a qualitative study

2022

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Surgical decision making in premenopausal BRCA carriers considering risk-reducing early salpingectomy or salpingo-oophorectomy: a qualitative study

2022

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Journal Article

Surgical decision making in premenopausal BRCA carriers considering risk-reducing early salpingectomy or salpingo-oophorectomy: a qualitative study

Newton, Claire,

Povolotskaya, Natalia,

Rosenthal, Adam,

Devaja, Omer,

Park, Claire,

Ragupathy, Kalpana,

Crosbie, Emma,

McCluggage, W Glenn,

Bryson, Gareth,

Hutson, Richard,

Sharma, Aarti,

Balega, Janos,

Side, Lucy,

Matthews, Nicholas,

Hamoodi, Ibraheem,

Willett, Mark,

Tailor, Anil,

Duncan, Tim,

Ghaem-Maghami, Sadaf,

Rowlands, Gareth,

Gaba, Faiza,

Saridogan, Ertan,

Taylor, Sian,

Edey, Katherine,

Chandrasekaran, Dhivya,

Menon, Usha,

Snape, Katie,

Rao, Sanjay,

Lutchman-Singh, Kerryn,

Chalhoub, Tony,

Phillips, Andrew,

Kaushik, Sonali,

Kodiathodi, Suma,

Tyson, Charlotte,

Seters, Manon van,

Arora, Rupali,

Chattopadhyay, Supratik,

Sundar, Sudha,

Abdul, Beena,

Fegan, Scott,

Peevor, Richard,

Brady, Angela,

Gurumurthy, Mahalakshmi,

Mehra, Gautam,

Evans, D Gareth,

Hanson, Helen,

Sengupta, Partha,

Goyal, Shivam,

Madhuri, Kavitha Thumuluru,

Ganesan, Raji,

Mackintosh, Michelle,

Borley, Jane,

Singh, Naveena,

Ahmed, Munaza,

Cameron, Iain,

Legood, Rosa,

Marks, Dalya,

Manchanda, Ranjit,

Williamson, Karin,

Robbani, Sadiyah,

Iyer, Rema,

Evans, Olivia

2022

Overview

BackgroundAcceptance of the role of the fallopian tube in ‘ovarian’ carcinogenesis and the detrimental sequelae of surgical menopause in premenopausal women following risk-reducing salpingo-oophorectomy (RRSO) has resulted in risk-reducing early-salpingectomy with delayed oophorectomy (RRESDO) being proposed as an attractive alternative risk-reducing strategy in women who decline/delay oophorectomy. We present the results of a qualitative study evaluating the decision-making process among BRCA carriers considering prophylactic surgeries (RRSO/RRESDO) as part of the multicentre PROTECTOR trial (ISRCTN:25173360).MethodsIn-depth semistructured 1:1 interviews conducted using a predeveloped topic-guide (development informed by literature review and expert consultation) until informational saturation reached. Wording and sequencing of questions were left open with probes used to elicit additional information. All interviews were audio-recorded, transcribed verbatim, transcripts analysed using an inductive theoretical framework and data managed using NVIVO-v12.ResultsInformational saturation was reached following 24 interviews. Seven interconnected themes integral to surgical decision making were identified: fertility/menopause/cancer risk reduction/surgical choices/surgical complications/sequence of ovarian-and-breast prophylactic surgeries/support/satisfaction. Women for whom maximising ovarian cancer risk reduction was relatively more important than early menopause/quality-of-life preferred RRSO, whereas those more concerned about detrimental impact of menopause chose RRESDO. Women managed in specialist familial cancer clinic settings compared with non-specialist settings felt they received better quality care, improved hormone replacement therapy access and were more satisfied.ConclusionMultiple contextual factors (medical, physical, psychological, social) influence timing of risk-reducing surgeries. RRESDO offers women delaying/declining premenopausal oophorectomy, particularly those concerned about menopausal effects, a degree of ovarian cancer risk reduction while avoiding early menopause. Care of high-risk women should be centralised to centres with specialist familial gynaecological cancer risk management services to provide a better-quality, streamlined, holistic multidisciplinary approach.

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Publisher

BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Publishing Group

Subject

/ Cardiovascular disease

/ Clinical Decision-Making

/ Clinics