Factors influencing uptake and timing of risk reducing salpingo-oophorectomy in women at risk of familial ovarian cancer: a competing risk time to event analysis
R Manchanda
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
Search for more papers by this authorM Burnell
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
Search for more papers by this authorA Abdelraheim
Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, London, UK
Department of Obstetrics and Gynaecology, El Minia University Hospitals, El Minia, Egypt
Search for more papers by this authorM Johnson
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
Search for more papers by this authorA Sharma
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
Search for more papers by this authorE Benjamin
Department of Pathology, Cancer Institute, Rockefeller Building, UCL, London
Search for more papers by this authorC Brunell
Department of Radiology, University College London Hospital (UCLH), London
Search for more papers by this authorS Gessler
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
Search for more papers by this authorD Oram
Department of Obstetrics and Gynaecology, El Minia University Hospitals, El Minia, Egypt
Search for more papers by this authorL Side
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
Search for more papers by this authorAN Rosenthal
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
Department of Obstetrics and Gynaecology, El Minia University Hospitals, El Minia, Egypt
Search for more papers by this authorI Jacobs
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
These authors made an equal contribution to this study.
Search for more papers by this authorU Menon
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
These authors made an equal contribution to this study.
Search for more papers by this authorR Manchanda
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
Search for more papers by this authorM Burnell
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
Search for more papers by this authorA Abdelraheim
Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, London, UK
Department of Obstetrics and Gynaecology, El Minia University Hospitals, El Minia, Egypt
Search for more papers by this authorM Johnson
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
Search for more papers by this authorA Sharma
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
Search for more papers by this authorE Benjamin
Department of Pathology, Cancer Institute, Rockefeller Building, UCL, London
Search for more papers by this authorC Brunell
Department of Radiology, University College London Hospital (UCLH), London
Search for more papers by this authorS Gessler
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
Search for more papers by this authorD Oram
Department of Obstetrics and Gynaecology, El Minia University Hospitals, El Minia, Egypt
Search for more papers by this authorL Side
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
Search for more papers by this authorAN Rosenthal
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
Department of Obstetrics and Gynaecology, El Minia University Hospitals, El Minia, Egypt
Search for more papers by this authorI Jacobs
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
These authors made an equal contribution to this study.
Search for more papers by this authorU Menon
Department of Gynaecological Oncology, EGA Institute for Women’s Health, UCL, London
These authors made an equal contribution to this study.
Search for more papers by this authorAbstract
Please cite this paper as: Manchanda R, Burnell M, Abdelraheim A, Johnson M, Sharma A, Benjamin E, Brunell C, Saridogan E, Gessler S, Oram D, Side L, Rosenthal A, Jacobs I, Menon U. Factors influencing uptake and timing of risk reducing salpingo-oophorectomy in women at risk of familial ovarian cancer: a competing risk time to event analysis. BJOG 2012;119:527–536.
Objective To evaluate factors affecting uptake of risk-reducing salpingo-oophorectomy (RRSO) over time in women at high-risk of familial ovarian cancer.
Design Prospective observational cohort.
Setting Tertiary high-risk familial gynaecological cancer clinic.
Population/sample New clinic attendees between March 2004 and November 2009, fulfilling the high-risk criteria for the UK Familial Ovarian Cancer Screening Study.
Methods Risk management options discussed included RRSO and ovarian surveillance. Outcome data were analysed from a bespoke database. The competing risk method was used to model the cumulative incidence function (CIF) of RRSO over time, and the sub-hazard ratio (SHR) was used to assess the strength of the association of variables of interest with RRSO. Gray’s test was used to evaluate the difference in CIF between two groups and multivariable competing risk regression analysis was used to model the cumulative probabilities of covariates on the CIF.
Results Of 1133 eligible women, 265 (21.4%) opted for RRSO and 868 (69.9%) chose screening. Women undergoing RRSO were older (49 years, interquartile range 12.2 years) than those preferring screening (43.4 years, interquartile range 11.9 years) (P < 0.0005). The CIF for RRSO at 5 years was 0.55 (95% CI 0.45–0.64) for BRCA1/2 carriers and 0.22 (95% CI 0.19–0.26) for women of unknown mutation status (P < 0.0001); 0.42 (95% CI 0.36–0.47) for postmenopausal women (P < 0.0001); 0.29 (95% CI 0.25–0.33) for parity ≥1 (P = 0.009) and 0.47 (95% CI 0.39–0.55) for a personal history of breast cancer (P < 0.0001). Variables of significance from the regression analysis were: a BRCA1/2 mutation (SHR 2.31, 95% CI 1.7–3.14), postmenopausal status (SHR 2.16, 95% CI 1.62–2.87)) and a personal history of breast cancer (SHR 1.5, 95% CI 1.09–2.06).
Conclusions Decision-making is a complex process and women opt for surgery many years after initial risk assessment. BRCA carriers, postmenopausal women and women who had breast cancer are significantly more likely to opt for preventative surgery.
Supporting Information
Figure S1. Criteria for women at high-risk of ovarian cancer.
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| BJO_3257_sm_FigureS1.jpg585.8 KB | Supporting info item |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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