Decision-making surrounding ovarian cancer risk-reducing surgery: perspectives from a diverse population

Individuals with BRCA1/2 pathogenic variants (PV) are recommended risk-reducing salpingo-oophorectomy between 35 and 45 years of age to prevent ovarian cancer. Trials evaluating the oncologic safety of risk-reducing salpingectomy are ongoing. One's decision on the type and timing of surgery has implications for fertility, quality of life, and long-term health. Published literature on patient preferences has focused on White women from North America and Europe; thus, findings are not necessarily generalizable to patients from other backgrounds. To address this gap, we sought to assess decision-making around ovarian cancer risk-reducing surgery among a racially and ethnically diverse population with BRCA1/2 PVs.

Between February 2023 and November 2023, patients with BRCA1/2 PVs were invited to participate in a one-time, semi-structured, one-on-one interview. Interviews were recorded, transcribed, and analyzed using an inductive approach by two independent coders.

Among 15 participants, the median age was 41 years (range 24-64). Ten participants identified as Hispanic, Black, or Asian. Two identified as gender queer. Six had a history of breast cancer. Ten had undergone risk-reducing surgery for ovarian cancer (seven salpingo-oophorectomy and three salpingectomy). Concerns about surgical menopause were a primary consideration for all participants. Other influencing factors included fertility, oncologic safety, history of breast cancer, sexual function, sense of control, gender identity, and mental health.

This study identified themes that influenced decision-making among BRCA1/2 PV carriers considering or having undergone risk-reducing gynecologic surgery in a racially and ethnically diverse population. These insights can help clinicians better support patients undergoing this process, with the objective of providing patient-centered, culturally sensitive care.