title: Risk reducing salpingectomy and delayed oophorectomy in high risk women: views of cancer geneticists, genetic counsellors and gynaecological oncologists in the UK.
abstract: Risk-reducing-salpingectomy and Delayed-Oophorectomy (RRSDO) is being proposed as a two-staged approach in place of RRSO to reduce the risks associated with premature menopause in high-risk women. We report on the acceptability/attitude of UK health professionals towards RRSDO. An anonymised web-based survey was sent to UK Cancer Genetics Group (CGG) and British Gynaecological Cancer Society (BGCS) members to assess attitudes towards RRSDO. Baseline characteristics were described using descriptive statistics. A Chi square test was used to compare categorical, Kendal-tau-b test for ordinal and Mann-Whitney test for continuous variables between two groups. 173/708 (24.4%) of invitees responded. 71% respondents (CGG = 57%/BGCS = 83%, p = 0.005) agreed with the tubal hypothesis for OC, 55% (CGG = 42%/BGCS = 66%, p = 0.003) had heard of RRSDO and 48% (CGG = 46%/BGCS = 50%) felt evidence was not currently strong enough for introduction into clinical practice. However, 60% respondents' (CGG = 48%/BGCS = 71%, p = 0.009) favoured offering RRSDO to high-risk women declining RRSO, 77% only supported RRSDO within a clinical trial (CGG = 78%/BGCS = 76%) and 81% (CGG = 76%/BGCS = 86%) advocated a UK-wide registry. Vasomotor symptoms (72%), impact on sexual function (63%), osteoporosis (59%), hormonal-therapy (55%) and subfertility (48%) related to premature menopause influenced their choice of RRSDO. Potential barriers to offering the two-stage procedure included lack of data on precise level of benefit (83%), increased surgical morbidity (79%), loss of breast cancer risk reduction associated with oophorectomy (68%), need for long-term follow-up (61%) and a proportion not undergoing DO (66%). There were variations in perception between BGCS/CGG members which are probably attributable to differences in clinical focus/expertise between these two groups. Despite concerns, there is reasonable support amongst UK clinicians to offering RRSDO to premenopausal high-risk women wishing to avoid RRSO, within a prospective clinical trial.
authors.affiliation: Department of Obstetrics and Gynaecology, Northampton General Hospital, Northampton, UK.
authors.forename: Dhivya
authors.initials: D
authors.lastname: Chandrasekaran
authors.affiliation: Department of Women's Cancer, EGA Institute for Women's Health, Gynaecological Cancer Research Centre, University College London, First Floor, Maple House, 149 Tottenham Court Road, London, W1T 7DN, UK.
authors.forename: Usha
authors.initials: U
authors.lastname: Menon
authors.affiliation: Department of Genetic Medicine, St Mary's Hospital, Manchester, UK.
authors.forename: Gareth
authors.initials: G
authors.lastname: Evans
authors.affiliation: Department of Gynaecological Oncology, Addenbrookes Hospital, Cambridge, UK.
authors.forename: Robin
authors.initials: R
authors.lastname: Crawford
authors.affiliation: Department of Gynaecology, University College London Hospital, London, UK.
authors.forename: Ertan
authors.initials: E
authors.lastname: Saridogan
authors.affiliation: Department of Clinical Genetics, Guys Hospital, London, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Jacobs
authors.affiliation: Department of Medical Genetics, University of Cambridge, Addenbrookes Hospital, Cambridge, UK.
authors.forename: Marc
authors.initials: M
authors.lastname: Tischkowitz
authors.affiliation: Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, UK.
authors.forename: Elly
authors.initials: E
authors.lastname: Brockbank
authors.affiliation: Department of Gynaecological Oncology, Bartshealth NHS Trust, Royal London Hospital, 10th Floor, South Block, Whitechapel Road, London, E1 1BB, UK.
authors.forename: Jatinder
authors.initials: J
authors.lastname: Kalsi
authors.affiliation: Department of Gynaecology, University College London Hospital, London, UK.
authors.forename: Davor
authors.initials: D
authors.lastname: Jurkovic
authors.affiliation: Department of Women's Cancer, EGA Institute for Women's Health, Gynaecological Cancer Research Centre, University College London, First Floor, Maple House, 149 Tottenham Court Road, London, W1T 7DN, UK. r.manchanda@ucl.ac.uk.|Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, UK. r.manchanda@ucl.ac.uk.|Department of Gynaecological Oncology, Bartshealth NHS Trust, Royal London Hospital, 10th Floor, South Block, Whitechapel Road, London, E1 1BB, UK. r.manchanda@ucl.ac.uk.
authors.forename: Ranjit
authors.initials: R
authors.lastname: Manchanda
mesh_terms: D001291:Attitude of Health Personnel; D019313:BRCA1 Protein / Q000235:genetics; D024682:BRCA2 Protein / Q000235:genetics; D005260:Female; D005817:Genetic Counseling; D020022:Genetic Predisposition to Disease; D018095:Germ-Line Mutation / Q000235:genetics; D006801:Humans; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000523:psychology; D010052:Ovariectomy / Q000379:methods* / Q000523:psychology; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D040242:Risk Reduction Behavior; D058994:Salpingectomy / Q000379:methods* / Q000523:psychology
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human
keywords: BRCA; Delayed oophorectomy; High-risk; Ovarian cancer; RRSDO; Risk reducing salpingectomy