Regular articleQuality of life in women at risk for ovarian cancer who have undergone risk-reducing oophorectomy
Introduction
It was estimated that 23,400 cases of ovarian cancer would be diagnosed in 2002, and 13,900 women would die of the disease [1]. A family history of ovarian cancer is an important risk factor for the disease, as first-degree relatives of cases have an approximately threefold increased risk [2]. A number of factors may contribute to the observed familial predisposition, especially the presence of a highly penetrant genetic susceptibility. Women from high-risk families transmitting deleterious BRCA1 mutations have been reported to be at 40–60% lifetime risk for ovarian cancer [3], and BRCA2 heterozygotes appear to be at 15–25% risk [4], [5].
The 5-year survival rate for all stages of ovarian cancer combined is approximately 50% [6]. However, only 25% of all ovarian cancers are detected at the localized stage and the 5-year survival for women with more advanced disease is considerably worse. The efficacy of screening for ovarian cancer has not been established. Biannual transvaginal ultrasound and CA125 measurement are recommended for women at high risk [7], but the ability of these procedures to improve survival remains uncertain. Because of this, a number of women at risk elect to undergo bilateral risk-reducing salpingo-oophorectomy (RRSO) [8].
Data bearing on the efficacy of RRSO in reducing ovarian cancer risk are now becoming available. A case–control study of women with germline BRCA1 or BRCA2 mutations suggested a risk reduction of approximately 96% in this group [9]. Smaller prospective cohort studies have also demonstrated a benefit to surgery [10]. Data on noncancer outcomes after RRSO are limited, but are strongly desired by women contemplating this surgery [11]. The current study was undertaken to assess symptomatology, overall health status, affective state, and sexual function in a cohort of women who had undergone RRSO because of an increased risk of ovarian cancer.
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Patients and recruitment procedures
The subjects of this study were women who had undergone risk-reducing salpingo-oophorectomy (RRSO) at Memorial Sloan–Kettering Cancer Center (MSKCC) between 1 January 1997 and 31 July 2000. Subjects (n = 101) were identified by review of the gynecologic oncology service procedure database. The great majority of women underwent laparoscopic RRSO without hysterectomy. After consent to contact was obtained from the attending surgeon, the potential subject was mailed a letter describing the study
Characteristics of the study population
Characteristics of the participants in the study are presented in Table 1. The 59 postoperative subjects completed the questionnaire at a mean of 23.5 months after RRSO (median, 21.3 months; range, 0.8–44.7 months). Mean age at the time of RRSO was 51.2 years, and most women (71.2%) in the post-RRSO group reported themselves to be postmenopausal at the time of surgery. The majority of women had a prior history of breast cancer (83.1%). At the time of RRSO, 3 women (5.1%) were found to have
Discussion
Because of the lack of evidence clearly demonstrating the effectiveness of ovarian cancer screening in reducing ovarian cancer mortality, women at risk for ovarian cancer may consider risk-reducing salpingo-oophorectomy for prevention. Previous studies of the psychosocial impact of this surgery have either employed qualitative assessments [11], [18], [19], or have been of smaller size [20], [21]. The present report is the largest and most detailed analysis to date of quality of life in women
Conclusions
To the best of our knowledge, this is the largest systematic investigation to date exploring symptoms, sexual function, and quality of life in women undergoing RRSO. In these women, symptoms related to estrogen deprivation were common. A particular issue that has not been well recognized was the frequent occurrence of sexual problems. These symptoms, and the consequent impact on sexual function, were the most important determinants of satisfaction with surgery. Despite these symptoms, women who
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