Study Finds Premenopausal Women Facing Increased Ovarian Cancer Risk Favor Removing Fallopian Tubes But Save Ovaries

September 11, 2020

A proposed preventive surgery that would take out fallopian tubes before menopause but save ovary removal until afterwards was favored by most premenopausal previvors of ovarian cancer in a study.

Most premenopausal women planning preventive surgery because of a predisposition to ovarian cancer would prefer to remove only their fallopian tubes, putting off removal of their ovaries until they reach menopause, a study shows.

This staging of preventive surgery would serve as an alternative to the standard preventive strategy for these patients, which involves removing the fallopian tubes and ovaries at the same time. Study authors say the new tactic would provide some protection against ovarian cancer without thrusting younger women into medically induced menopause.

It is not yet clear how protective the new strategy will be against the development of ovarian cancer compared with the standard strategy, but the staged surgery would allow younger women to avoid the side effects associated with early menopause, which can include an increased risk of heart disease, osteoporosis, neurocognitive decline and sexual dysfunction, according to a press release issued by Queen Mary University of London, whose researchers led the study on attitudes toward the proposed new protocol. Results of the study, conducted at multiple centers in the U.K., were published in The British Journal of Obstetrics Gynaecology.

Another potential benefit of the staged surgery is that it might reduce the number of women who delay or decline preventive surgery altogether due to concern about early menopause, study senior author Professor Ranjit Manchanda, of Queen Mary’s Wolfson Institute of Preventive Medicine and Barts Health NHS Trust, said in the release.

Women can face increased risk of developing ovarian cancer due to inherited mutations to genes such as the BRCA1 or BRCA2 mutation.

The study included 638 women who faced an increased risk of developing ovarian cancer. Of them, 346 had undergone standard risk-reducing surgery and 337 women had not undergone surgery. To gauge their attitudes about the staged surgery researchers asked them to fill out a 39-item questionnaire.

Among those who had undergone standard surgery, 9.4% of women who were premenopausal at that time (15 of 160) and 1.2% of women who were postmenopausal presurgically (1 of 81) regretted their decision, the authors reported. Of premenopausal women who had not undergone surgery, 69% said they would find it acceptable to participate in a research study offering the proposed new surgical option. Among women who did undergo surgery while premenopausal, 38% said that, given the choice, they would have potentially opted for the two-step operation.

The new staged surgical protocol was considered especially acceptable by premenopausal women concerned about sexual dysfunction as a result of ovary removal and those already experiencing that issue post-surgery, the authors found.

About 74% of the premenopausal women in the study who had undergone standard preventive surgery, and did not have breast cancer (80 of 108), were taking hormone replacement therapy, the authors noted.

“While hormone replacement therapy (HRT) has been shown to mitigate some symptoms, it does not appear to alleviate sexual dysfunction or increase satisfaction levels following standard preventive surgery involving removal of ovaries,” the study’s lead author, Dr. Faiza Gaba of Queen Mary’s Wolfson Institute, said in the release.

Premenopausal women in the U.K. who are predisposed to ovarian cancer now have the option of joining the PROTECTOR study, in which they’ll be able to choose staged surgery, conventional surgery or no surgery. The main goal of the study will be to evaluate the impact on sexual function when women in this population receive staged surgery.


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