Health Care Provider Adherence to Surgical Guidelines for Risk-Reducing Salpingo-Oophorectomy

Wilhite, Annelise; Oestreich, Makinna; Olson, Megan; Bedell, Sabrina M.; Westenberg, Danielle; Bangdiwala, Ananta S; Ikramuddin, Salman; Sanchez-Avila, Monica; Madoff, Robert D.; Khalifa, Mahmoud A.; Erickson, Britt

doi:10.1097/aog.0000000000003421

Cited by 9 publications

(9 citation statements)

References 14 publications

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“…Ob-gyns performed 32% of the prophylactic BSO, lower than previously reported in the study of Wilhite et al 24 on adherence to the recommended surgical protocol for prophylactic BSO, which found that 45% of prophylactic BSOs were conducted by ob-gyns. This difference is possibly attributable to geographic variation.…”

Section: Discussioncontrasting

confidence: 62%

Barriers to hormone therapy following prophylactic bilateral salpingo-oophorectomy in BRCA1/2 mutation carriers

et al. 2023

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Objective: This study aimed to identify barriers to hormone therapy (HT) use among women with BRCA1/2 mutations after prophylactic bilateral salpingo-oophorectomy (BSO).Methods: A cross-sectional, electronic survey was conducted of BRCA1/2 mutation carriers at Women and Infants Hospital, Yale Medical Center, Hartford Healthcare, and Maine Medical Center. This study was a subanalysis of a subset of female BRCA1/2 mutation carriers who had undergone a prophylactic BSO. Data were analyzed using the Fisher's exact test or t test.Results: We performed a subanalysis of 60 BRCA mutation carriers who underwent a prophylactic BSO. Only 24 women (40%) reported ever using HT. HTuse was higher in women who underwent their prophylactic BSO at age younger than 45 years (51% vs. 25%, P = 0.06). Among all women who had a prophylactic BSO, the majority (73%) reported that a provider talked to them about using HT. Two thirds reported having seen contradictory information in the media about long-term consequences of HT. Seventy percent listed their provider as the primary influence in their decision to start HT. The most common reasons for not starting HT included it not being recommended by their physician (46%) and that it was not necessary (37%).Conclusions: BRCA mutation carriers frequently undergo prophylactic BSO at young ages, and less than half report using HT. This study highlights barriers to HT use, such as patient fears and physician discouragement, and identifies potential areas to improve educational efforts.

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Section: Discussioncontrasting

confidence: 62%

Barriers to hormone therapy following prophylactic bilateral salpingo-oophorectomy in BRCA1/2 mutation carriers

et al. 2023

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“…Data have consistently shown higher adherence rate with recommended practices for risk-reducing surgery when patients are followed by gynecologic oncologists in addition to higher rates of diagnosis of occult neoplasms. 66,69 Therefore, referral to gynecologic oncology is highly recommended.…”

Section: Role Of Gynecologic Oncologists In Screening and Performing ...mentioning

confidence: 99%

Controversies in Hereditary Cancer Management

AlHilli

Pederson

2021

Obstetrics &Amp; Gynecology

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Personalized management of patients at risk ideally should involve a multidisciplinary team of not only genetic counselors and surgeons, but also women's health or menopause specialists, knowledgeable psychologists, and primary care providers or obstetrician–gynecologists aware of the risks and fears “previvors” (survivors of a predisposition to cancer who have not had the disease) face as well as the issues that are common postoperatively. Identification of patients at risk for hereditary cancer, understanding of current genetic testing modalities and potential results, knowledge about screening and prevention including timing of surveillance, preventive medication and risk-reducing surgeries, understanding limitations and comorbidities associated with these risk management strategies and long-term psychological support are all important in hereditary cancer management. We describe issues surrounding the identification of the high-risk patient, universal testing in breast and ovarian cancer, and testing in special populations. We describe a simplified approach to understanding and communicating genetic testing results and nuances of testing including direct-to-consumer testing. We highlight concerns surrounding breast cancer screening during pregnancy and lactation. A framework for practical management and counseling of women who opt for risk-reducing salpingo-oophorectomy or risk-reducing mastectomy or both is provided. We provide an in-depth discussion of questions that arise in relation to timing of surgery, fertility preservation, management of menopausal symptoms, and surgical technique. Alternative choices in women who choose to delay bilateral salpingo-oophorectomy are reviewed. Finally, the psychosocial effects of carrying a genetic mutation and the issues that women face when undergoing to risk-reducing surgery including adjustment, sexuality issues, and cosmesis are addressed.

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“…Even with all the evidence of the benefits of this surgery in high-risk women, there is a considerable number of gynecologists who resist to indicate prophylactic surgeries in women of proven risk. (40) However, as genetic assessments and tests become more used, they are likely to increase acceptance and availability of procedures. In any case, it is important that this is done in reference centers and by competent specialists to evaluate clinical data and genetic tests.…”

Section: Risk-reducing Bilateral Salpingooophorectomy (Rrbso)mentioning

confidence: 99%

“…In any case, it is important that this is done in reference centers and by competent specialists to evaluate clinical data and genetic tests. (40) In Brazil, at present, it is still difficult to include genetic testing and prophylactic procedures in clinical practice, but this demands work until becoming a reality, including in the National Health Service (Brazilian SUS). (41) Early risk-reducing bilateral salpingectomy and late bilateral oophorectomy An alternative that is being tested to circumvent these problems is early salpingectomy and late oophorectomy.…”

Section: Risk-reducing Bilateral Salpingooophorectomy (Rrbso)mentioning

confidence: 99%