Factors affecting surgical decision making in BRCA carriers undergoing risk reducing surgery

Objectives Women with germline BRCA1/2 mutations have a significantly elevated lifetime risk of ovarian cancer. Risk-reducing bilateral salpingo-oopherectomy (RRSO) is associated with an 80% reduction in the development of ovarian cancer. In January 2014 the Familial Ovarian Cancer Clinic (FOCC) was created as a centralized clinic to manage referrals of women with documented BRCA1/2 mutations. The objective of this study was to evaluate the choices that Canadian women with BRCA1/2 mutations made regarding ovarian cancer risk reduction within this highly specialized multidisciplinary clinic. Methods A retrospective chart review was performed on all women with confirmed BRCA1/2 mutations referred to the FOCC at Women's College Hospital, Toronto, Canada over a 45-month time period. Patient demographics, preoperative investigations, intraoperative findings and pathology were recorded. Results A total of 191 women were included in our cohort; 140(73.3%) underwent RRS and 51 (26.7%) deferred or declined surgery. In women who underwent RRS (median age 45 [30-72] years), 123 (87.9%) underwent RRSO and 17 (12.1%) chose a two-step risk-reducing bilateral salpingectomy with delayed oophorectomy (RRSDO). Of the women undergoing RRSO, 11 (8.9%) women chose concurrent hysterectomy. Prevalent themes affecting decision making included fears around premature surgical menopause, family planning, and concerns around development of endometrial cancer related to tamoxifen. Conclusions Women with BRCA1/2 mutations referred to our FOCC clinic face challenging decisions regarding risk reduction.