Predictors of prophylactic bilateral salpingo-oophorectomy compared with gynecologic screening use in BRCA1/2 mutation carriers.
OBJECTIVE
Women with BRCA1/2 gene mutations who have completed their childbearing are strong candidates for risk-reducing prophylactic bilateral salpingo-oophorectomy (PBSO). The aim of the current study was to identify baseline predictors of PBSO versus gynecologic screening (GS) in this group of high-risk women.


METHODS
Baseline questionnaires were available from 160 BRCA1/2 carriers who participated in a nationwide, longitudinal, observational study of the psychosocial consequences of prophylactic surgery versus periodic screening. Topics addressed by the questionnaire included generic quality of life, cancer-specific distress, risk perception, knowledge of ovarian cancer, and perceived pros and cons of surgery versus screening. PBSO use during the 12-month period after the first gynecologic consultation was determined on the basis of medical record data.


RESULTS
During the 12-month follow-up period, 74% of women had undergone PBSO, and 26% opted for screening. Statistically significant multivariate predictors of PBSO included education, general health perceptions, perceived incurability of ovarian cancer, and perceived benefits of surgery.


CONCLUSIONS
Women with lower educational levels, with poorer general health perceptions, who view ovarian cancer as an incurable disease, and who believe more strongly in the benefits of surgery are more likely to undergo PBSO. Clinicians should ensure that high-risk women are well informed about the low predictive value of GS techniques and about the lethal threat posed by ovarian cancer because of its limited curability.
Madalinska
Joanna B
JB
Division of Psychosocial Research and Epidemiology, Department of Gynecology, the Netherlands Cancer Institute, Amsterdam, The Netherlands.
van Beurden
Marc
M
Bleiker
Eveline M A
EM
Valdimarsdottir
Heiddis B
HB
Lubsen-Brandsma
Lottie
L
Massuger
Leon F
LF
Mourits
Marian J E
MJ
Gaarenstroom
Katja N
KN
van Dorst
Eleonora B L
EB
van der Putten
Hans
H
Boonstra
Henk
H
Aaronson
Neil K
NK
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D004522:Educational Status; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D019538:Health Care Surveys; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000235:genetics* / Q000517:prevention & control*; D010052:Ovariectomy; D011237:Predictive Value of Tests; D011379:Prognosis; D011788:Quality of Life