PT - JOURNAL ARTICLE AU - Faiza Gaba AU - Shivam Goyal AU - Dalya Marks AU - Dhivya Chandrasekaran AU - Olivia Evans AU - Sadiyah Robbani AU - Charlotte Tyson AU - Rosa Legood AU - Ertan Saridogan AU - W Glenn McCluggage AU - Helen Hanson AU - Naveena Singh AU - D Gareth Evans AU - Usha Menon AU - Ranjit Manchanda ED - , TI - Surgical decision making in premenopausal <em>BRCA</em> carriers considering risk-reducing early salpingectomy or salpingo-oophorectomy: a qualitative study AID - 10.1136/jmedgenet-2020-107501 DP - 2022 Feb 01 TA - Journal of Medical Genetics PG - 122--132 VI - 59 IP - 2 4099 - http://jmg.bmj.com/content/59/2/122.short 4100 - http://jmg.bmj.com/content/59/2/122.full SO - J Med Genet2022 Feb 01; 59 AB - Background Acceptance of the role of the fallopian tube in ‘ovarian’ carcinogenesis and the detrimental sequelae of surgical menopause in premenopausal women following risk-reducing salpingo-oophorectomy (RRSO) has resulted in risk-reducing early-salpingectomy with delayed oophorectomy (RRESDO) being proposed as an attractive alternative risk-reducing strategy in women who decline/delay oophorectomy. We present the results of a qualitative study evaluating the decision-making process among BRCA carriers considering prophylactic surgeries (RRSO/RRESDO) as part of the multicentre PROTECTOR trial (ISRCTN:25173360).Methods In-depth semistructured 1:1 interviews conducted using a predeveloped topic-guide (development informed by literature review and expert consultation) until informational saturation reached. Wording and sequencing of questions were left open with probes used to elicit additional information. All interviews were audio-recorded, transcribed verbatim, transcripts analysed using an inductive theoretical framework and data managed using NVIVO-v12.Results Informational saturation was reached following 24 interviews. Seven interconnected themes integral to surgical decision making were identified: fertility/menopause/cancer risk reduction/surgical choices/surgical complications/sequence of ovarian-and-breast prophylactic surgeries/support/satisfaction. Women for whom maximising ovarian cancer risk reduction was relatively more important than early menopause/quality-of-life preferred RRSO, whereas those more concerned about detrimental impact of menopause chose RRESDO. Women managed in specialist familial cancer clinic settings compared with non-specialist settings felt they received better quality care, improved hormone replacement therapy access and were more satisfied.Conclusion Multiple contextual factors (medical, physical, psychological, social) influence timing of risk-reducing surgeries. RRESDO offers women delaying/declining premenopausal oophorectomy, particularly those concerned about menopausal effects, a degree of ovarian cancer risk reduction while avoiding early menopause. Care of high-risk women should be centralised to centres with specialist familial gynaecological cancer risk management services to provide a better-quality, streamlined, holistic multidisciplinary approach.Data are available on reasonable request.