Prophylactic Oophorectomy and Screening Use in Women at Increased Risk for Breast/ Ovarian Cancer
December 1, 1999 3 minutes read
Prophylactic Oophorectomy and Screening Use in Women at Increased Risk for Breast/ Ovarian Cancer
Abstract & commentary
Synopsis: Breast/ovarian cancer anxiety rather than objective risk is the major factor that determines a woman’s attitude toward prophylactic oophorectomy.
Source: Meiser B, et al. Gynecol Oncol 1999;75: 122-129.
Meiser and colleagues have reported a study in which 95 unaffected women, who approached one of 14 familial cancer clinics for advice about their breast/ovarian cancer risk and surveillance and prophylactic options, were assessed in a cross-sectional design when they attended the clinic. The aim of the study was to evaluate ovarian cancer screening uptake and attitudes toward prophylactic oophorectomy in women at risk of developing hereditary breast/ovarian cancer. Among high-risk women ages 30 and older who had not had a prophylactic oophorectomy, 48% reported ever having had an ovarian ultrasound and, among women ages 50 and older, 23% had taken a serum CA 125 test. Twenty-three percent of women would consider, and 27% of women would not consider, a prophylactic oophorectomy should the genetic test indicate a germline mutation associated with hereditary breast/ovarian cancer, while 38% were uncertain. Twelve percent had already undergone a prophylactic oophorectomy. Interest in prophylactic oophorectomy was associated with increased breast/ovarian cancer anxiety but not objective cancer risk. Meiser et al conclude that the findings demonstrate that breast/ovarian cancer anxiety rather than objective risk is the major factor that determines women’s attitude to prophylactic oophorectomy. Furthermore, they conclude that women are likely to benefit from interventions aimed at reducing breast/ovarian cancer anxiety and recommend further research on the use of prophylactic oophorectomy to develop educational strategies and decision aids to assist women who are trying to make a decision with conditions of uncertainty.
Comment by David M. Gershenson, MD
There still is no effective screening test for ovarian cancer. Current strategies being studied include a panel of serum tumor markers and combined modality screening (e.g., the use of a combination of CA 125 testing and transvaginal ultrasound based on an algorithm). Several groups and centers have focused on so-called "high-risk" women, who are defined by their family history of ovarian or breast cancer or a personal history of breast cancer. Other possible factors include age and ethnicity. I strongly believe that high-risk women should consider enrolling in a comprehensive screening/genetics program that offers pedigree analysis, risk assessment, genetic counseling, psychological counseling, and selective genetic testing and interventions in addition to the usual CA 125 and sonogram. Such programs should be research-driven so that we can learn how best to improve outcomes for high-risk women. The most interesting finding of this article is that women’s attitudes about prophylactic oophorectomy are determined more by anxiety than by objective information. Other recent studies have noted similar findings. I agree with Meiser et al that such information will allow us to develop appropriate interventions to reduce anxiety so that greater objective decision making can occur. Of course, as Meiser et al point out, we don’t know whether such attitudes will translate into actual behavior. In addition, we still have a lot to learn about the effect of prophylactic oophorectomy in reducing the incidence of ovarian or peritoneal cancer in high-risk women.
30. Effective ovarian cancer screening for high-risk women consists of:
a. transvaginal ultrasound.
b. serum CA 125.
c. transvaginal ultrasound plus serum CA 125.
d. operative laparoscopy.
e. None of the above
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