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Wolfson Institute of Preventive Medicine - Barts and The London

Proposed new surgery protocol highly acceptable among premenopausal women at increased risk of ovarian cancer

For women at high risk of ovarian cancer, standard preventive practice is to offer removal of both the fallopian tubes and ovaries, but the surgery induces menopause in women who have not yet reached this stage of life. A study led by researchers from Queen Mary’s Wolfson Institute has found that, among those who undergo this risk reducing surgery, premenopausal women have much higher regret rates than postmenopausal women. A proposed alternative two step surgical protocol, which delays the induced menopause caused by the removal of the ovaries, is highly acceptable to this premenopausal group of women.

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Because standard risk reducing surgery induces menopause, some women at high risk of ovarian cancer delay surgery until after they reach menopause. This delay places them in a 6-16 year period of much higher risk. Trials are underway to assess an alternative procedure, where the fallopian tubes are removed to offer some risk reduction, but ovary removal is delayed until women have reached menopause. This two step procedure, “Risk Reducing Early Salpingectomy Delayed Oophorectomy”, may avoid detrimental consequences of premature surgically induced menopause, including increased risk of heart-disease, osteoporosis, vasomotor-symptoms, neurocognitive decline, and sexual-dysfunction, especially in women who do not use hormone-replacement-therapy.

In this multicentre UK survey, researchers examined the acceptability and effect of the proposed alternative surgical protocol. The 638 study participants were all at increased risk of ovarian cancer; 346 had undergone standard risk reducing surgery, and 337 had not. Among those who had undergone standard preventive surgery, 9.4% of premenopausal and 1.2% of postmenopausal women regretted their decision. Of premenopausal women who had not undergone standard surgery, 69% found it acceptable to participate in a research study offering the proposed new surgical option. The study showed that the new two step surgical protocol was particularly acceptable to women concerned about the sexual dysfunction side effects of ovary removal.

Lead researcher Ranjit Manchanda, Consultant Gynaecological Oncologist at Barts Health and Professor at Queen Mary’s Wolfson Institute said: “The new two-step operation offers additional options for women to reduce their ovarian cancer risk, while avoiding the negative impact of early menopause. Our study shows that a large proportion of eligible women wish to consider this, and UK women have the option of joining the PROTECTOR (Preventing Ovarian Cancer through early Excision of Tubes and late Ovarian Removal) research study (www.protector.org.uk)”

This work was supported by funding from the Rosetrees Trust and Barts Charity.

Faiza Gaba, Oleg Blyuss, Dhivya Chandrasekaran, Miski Osman, Shivam Goyal, Carmen Gan, Louise Izatt, Vishakha Tripathi, Irene Esteban, Lewis McNicol, Kalpana Ragupathy, Robin Crawford, D. Gareth Evans, Rosa Legood, Usha Menon, Ranjit Manchanda. Attitudes towards Risk Reducing Early Salpingectomy with Delayed Oophorectomy for Ovarian Cancer Prevention: a Cohort Study. BJOG 2020.