Surveillance or surgery? A description of the factors that influence high risk premenopausal women's decisions about prophylactic oophorectomy

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Abstract
Editor—Approximately 5% of cases of epithelial ovarian cancer result from an inherited susceptibility.1 Some of the genetic mutations responsible have recently been identified.2-5 It is estimated that BRCA1 carriers have a 28% lifetime risk of developing ovarian cancer,6 while BRCA2 carriers have a risk of 0.4% of developing ovarian cancer at the age of 50, which rises to 27% by the age of 70.7 The recommended management of high risk women is either annual ovarian screening (transvaginal ultrasound) with serum CA125 measurement or bilateral prophylactic oophorectomy from the age of 35 onwards, or once childbearing is completed.8-11 As there is no evidence that ovarian screening is effective in reducing mortality, it is currently assumed that prophylactic surgery is the best form of risk management,12-14 although data suggest that intra-abdominal carcinomas may still arise following this procedure.15-17 There is little published research on the uptake of preventative surgery in at risk women18 or mutation carriers.19 20 However, it is generally assumed that there will be an increase in demand for prophylactic surgery, as direct mutation testing becomes more widely available. Epidemiological studies suggest that prophylactic oophorectomy may play a role in the prevention of breast cancer in high risk populations.21 22 Therefore, there may be a case for informing women at risk of breast cancer about this option. If health professionals are to facilitate informed decision making about ovarian cancer risk management, then they need to be aware of the factors that influence women's decisions about prophylactic surgery. There are few published data that describe the factors that influence women's decisions to undergo prophylactic surgery because of their inherited risk of developing cancer. Studies of high risk women who have undergone prophylactic mastectomy to manage their risk of breast …