title: Factors associated with deciding between risk-reducing salpingo-oophorectomy and ovarian cancer screening among high-risk women enrolled in GOG-0199: An NRG Oncology/Gynecologic Oncology Group study.
abstract: Women at increased genetic risk of ovarian cancer (OC) are recommended to have risk-reducing salpingo-oophorectomy (RRSO) after completion of reproductive planning. Effective screening has not been established, and novel screening modalities are being evaluated.
  
  
  
  Participants chose either RRSO or a novel OC screening regimen (OCS) as their risk management option, and provided demographic and other data on BRCA mutation status, cancer worry, perceived intervention risks/benefits, perceived cancer risk, and quality-of-life at enrollment. We performed univariate and multivariate analyses to evaluate factors influencing decision between RRSO and OCS.
  
  
  
  Of 2287 participants enrolled, 904 (40%) chose RRSO and 1383 (60%) chose OCS. Compared with participants choosing OCS, participants choosing RRSO were older (p<0.0001), more likely to carry deleterious BRCA1/2 mutations (p<0.0001), perceive RRSO as effective, be more concerned about surgical harms and OCS limitations, and report higher perceived OC risk and OC-related worry. OCS participants were more likely to perceive screening as effective, be more concerned about menopausal symptoms, infertility, and loss of femininity, and report better overall quality-of-life. Twenty-four percent of participants believed they would definitely develop OC, and half estimated their lifetime OC risk as >50%, both higher than objective risk estimates.
  
  
  
  Cancer worry, BRCA1/2 mutation status, and perceived intervention-related risks and benefits were associated with choosing between RRSO and OCS. Efforts to promote individualized, evidence-based, shared medical decision-making among high-risk women facing management choices should focus on conveying accurate OC risk estimates, clarifying the current understanding of intervention-related benefits and limitations, and addressing OC worry.
authors.affiliation: Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852-9772, United States. Electronic address: maip@mail.magee.edu.
authors.forename: Phuong L
authors.initials: PL
authors.lastname: Mai
authors.affiliation: NRG Oncology, Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States. Electronic address: marion.piedmonte@gmail.com.
authors.forename: Marion
authors.initials: M
authors.lastname: Piedmonte
authors.affiliation: Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME 04101, United States. Electronic address: hanp@mmc.org.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Han
authors.affiliation: Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20850, United States. Electronic address: moserr@mail.nih.gov.
authors.forename: Richard P
authors.initials: RP
authors.lastname: Moser
authors.affiliation: Stephenson Cancer Center, Department of Gynecologic Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, United States. Electronic address: joan-walker@ouhsc.edu.
authors.forename: Joan L
authors.initials: JL
authors.lastname: Walker
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL 60201, United States. Electronic address: GRodriguez@northshore.org.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Rodriguez
authors.affiliation: Gynecologic Oncology Program, University of North Carolina, Chapel Hill, NC 27514, United States. Electronic address: john_boggess@med.unc.edu.
authors.forename: John
authors.initials: J
authors.lastname: Boggess
authors.affiliation: Gynecologic Oncology, Yale University School of Medicine, New Haven, CT 06520, United States. Electronic address: thomas.rutherford@yale.edu.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Rutherford
authors.affiliation: Innovative Surgical Technology, Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10022, United States. Electronic address: zivanovo@mskcc.org.
authors.forename: Oliver
authors.initials: O
authors.lastname: Zivanovic
authors.affiliation: Division of Gynecologic Oncology, Ohio State University College of Medicine, Columbus, OH, United States. Electronic address: David.Cohn@osumc.edu.
authors.forename: David E
authors.initials: DE
authors.lastname: Cohn
authors.affiliation: Division of Medical Oncology, University of Mississippi Medical Center, Jackson, MS 39216, United States. Electronic address: jtthigpen@att.net.
authors.forename: J Tate
authors.initials: JT
authors.lastname: Thigpen
authors.affiliation: Department of Gynecologic Oncology, Program of Chemical Biology and Molecular Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States. Electronic address: Robert.Wenham@moffitt.org.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Wenham
authors.affiliation: Medical Oncology, The Prince of Wales Hospital, Randwick, NSW 2031, Australia. Electronic address: michael.friedlander@sesiahs.health.nsw.gov.au.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Friedlander
authors.affiliation: Gynecologic Cancer Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States. Electronic address: chad.a.hamilton2.mil@mail.mil.
authors.forename: Chad A
authors.initials: CA
authors.lastname: Hamilton
authors.affiliation: Department of GYN Surgery, Mayo Clinic, Rochester, MN 55905, United States. Electronic address: bakkum.jamie@mayo.edu.
authors.forename: Jamie
authors.initials: J
authors.lastname: Bakkum-Gamez
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, PA 15143, United States. Electronic address: olawaiyea@mail.magee.edu.
authors.forename: Alexander B
authors.initials: AB
authors.lastname: Olawaiye
authors.affiliation: Gynecologic Medical Oncology Service, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY 10065, United States. Electronic address: hensleym@mskcc.org.
authors.forename: Martee L
authors.initials: ML
authors.lastname: Hensley
authors.affiliation: Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20852-9772, United States. Electronic address: greenem@mail.nih.gov.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Greene
authors.affiliation: NRG Oncology, Statistical and Data Center, Roswell Park Cancer Institute, Buffalo, NY 14263, United States. Electronic address: huangh@nrgoncology.org.
authors.forename: Helen Q
authors.initials: HQ
authors.lastname: Huang
authors.affiliation: Center for Health Policy Research, University of California, Irvine, Irvine, CA 92697, United States. Electronic address: lwenzel@uci.edu.
authors.forename: Lari
authors.initials: L
authors.lastname: Wenzel
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002755:Choice Behavior; D015331:Cohort Studies; D055088:Early Detection of Cancer; D004522:Educational Status; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D009154:Mutation; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000517:prevention & control*; D010052:Ovariectomy; D010465:Perception; D065286:Prophylactic Surgical Procedures; D011446:Prospective Studies; D011788:Quality of Life; D012306:Risk; D040242:Risk Reduction Behavior; D058994:Salpingectomy