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Predictors of Prophylactic Bilateral Salpingo-Oophorectomy Compared With Gynecologic Screening Use in BRCA1/2 Mutation Carriers

Joanna B. Madalinska, Marc van Beurden, Eveline M.A. Bleiker, Heiddis B. Valdimarsdottir, Lottie Lubsen-Brandsma, Leon F. Massuger, Marian J.E. Mourits, Katja N. Gaarenstroom, Eleonora B.L. van Dorst, Hans van der Putten, Henk Boonstra, Neil K. Aaronson

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

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

PURPOSE: 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.

PATIENTS AND 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.

CONCLUSION: 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.

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

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

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