Originally published as JCO Early Release 10.1200/JCO.2005.02.626 on August 29 2005

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Quality-of-Life Effects of Prophylactic Salpingo-Oophorectomy Versus Gynecologic Screening Among Women at Increased Risk of Hereditary Ovarian Cancer

From the Division of Psychosocial Research and Epidemiology, Department of Gynecology, The Netherlands Cancer Institute; Department of Gynecology, Vrije University Medical Center; Department of Gynecology, Academic Medical Center, Amsterdam; Department of Gynecology, University Medical Center Nijmegen, Nijmegen; Department of Gynecology, Leiden University Medical Center, Leiden; Department of Gynecology, Academic Hospital Groningen, Groningen; Department of Gynecology, University Medical Center Utrecht, Utrecht; Department of Gynecology, Academic Hospital Maastricht, Maastricht, the Netherlands; and Department of Psychiatry, Mount Sinai School of Medicine, New York, NY

Address reprint requests to Neil K. Aaronson, PhD, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands; e-mail: n.aaronson{at}nki.nl

PURPOSE: Recommendations for women at high risk of ovarian cancer include periodic gynecologic screening (GS) and prophylactic bilateral salpingo-oophorectomy (PBSO). The aim of the current study was to determine the quality-of-life (QOL) effects of PBSO versus GS.

PATIENTS AND METHODS: Questionnaire data were obtained from 846 high-risk women who had participated in this nationwide, cross-sectional, observational study. Forty-four percent of the women had undergone PBSO, and 56% had opted for GS. Topics addressed by the questionnaire included generic QOL, cancer-specific distress, endocrine symptoms, and sexual functioning.

RESULTS: No statistically significant between-group differences were observed in generic QOL (Short Form-36), with women in both the PBSO and GS groups scoring similarly to the general population. Compared with GS, PBSO was associated with fewer breast and ovarian cancer worries (P < .001) and more favorable cancer risk perception (P < .05). However, the PBSO group reported significantly more endocrine symptoms (P < .001) and worse sexual functioning (P < .05) than the GS group. Eighty-six percent of women would choose PBSO again, and 63% would recommend it to a friend with familial risk of ovarian cancer.

CONCLUSION: PBSO had no measurable adverse impact on generic QOL of high-risk women. The favorable effects of PBSO in terms of reduced cancer worries and low perceived cancer risk need to be weighed against the increase in endocrine and sexual symptoms. Balanced information will help clinicians and high-risk women to make informed decisions about the optimal preventive health strategy.

Supported by Grant No. NKI 2001-2382 from the Dutch Cancer Society.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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