Quality of life in women at risk for ovarian cancer who have undergone risk-reducing oophorectomy

Hensley, Martee L.; Barakat, Richard R.; Brown, Carol L.; Chi, D.S.; Poynor, Elizabeth; Offit, Kenneth

doi:10.1016/s0090-8258(03)00072-6

Cited by 124 publications

(140 citation statements)

References 20 publications

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“…The women in our series reported fewer endocrine symptoms than those described in previous series [5,7]. The main difference between our study and those series [5,7] is the mean interval since PBSO, which were 1.9 years and 2.8 years of follow-up after PBSO, versus 6 years in our study.…”

Section: Discussioncontrasting

confidence: 87%

“…The main difference between our study and those series [5,7] is the mean interval since PBSO, which were 1.9 years and 2.8 years of follow-up after PBSO, versus 6 years in our study. We assume that such symptoms may be alleviated over time.…”

Section: Discussioncontrasting

confidence: 86%

“…However, this population appeared to have high endocrine symptom scores and lower sexual functioning. This has also been more or less described in other publications [5,7,8,15,16].…”

Section: Discussionsupporting

confidence: 57%

“…Before the analysis, we selected 19 clinically relevant variables from previous articles [5][6][7][8] and from sociodemographic questionnaires as factors potentially associated with "poor" postoperative results. Continuous variables were dichotomized a priori at the median.…”

Section: Discussionmentioning

confidence: 99%

“…Identifying women likely to experience a lower overall well-being after PBSO could potentially facilitate preoperative counseling and pre-or postoperative management. For this purpose, we selected both physical determinants and factors that could potentially influence their psychological well-being or worries about cancer from the available literature [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Altered Long-Term Well-Being After Prophylactic Salpingo-Oophorectomy Among Women at Increased Hereditary Risk for Breast and Ovarian Cancer

et al. 2011

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After completing this course, the reader will be able to:1. Describe factors associated with decreased well-being after PBSO in order to prospectively identify patients at risk.2. Provide pre-operative counseling and information to patients at risk of decreased well-being after PBSO.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTBackground. Prophylactic bilateral salpingo-oophorectomy (PBSO) might alter several components of wellbeing, such as sexual functioning and endocrine symptoms, in women at high risk for hereditary breast and/or ovarian cancer, compared with the general pop-

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Section: Discussioncontrasting

confidence: 87%

Section: Discussioncontrasting

confidence: 86%

“…However, this population appeared to have high endocrine symptom scores and lower sexual functioning. This has also been more or less described in other publications [5,7,8,15,16].…”

Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors Associated with Altered Long-Term Well-Being After Prophylactic Salpingo-Oophorectomy Among Women at Increased Hereditary Risk for Breast and Ovarian Cancer

et al. 2011

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Cost-Effectiveness of Population-Based Multigene Testing for Breast and Ovarian Cancer Prevention

Guo,

Adekanmbi,

Hsu

et al. 2024

JAMA Netw Open

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ImportanceThe current method of BRCA testing for breast and ovarian cancer prevention, which is based on family history, often fails to identify many carriers of pathogenic variants. Population-based genetic testing offers a transformative approach in cancer prevention by allowing for proactive identification of any high-risk individuals and enabling early interventions.ObjectiveTo assess the lifetime incremental effectiveness, costs, and cost-effectiveness of population-based multigene testing vs family history–based testing.Design, Setting, and ParticipantsThis economic evaluation used a microsimulation model to assess the cost-effectiveness of multigene testing (BRCA1, BRCA2, and PALB2) for all women aged 30 to 35 years compared with the current standard of care that is family history based. Carriers of pathogenic variants were offered interventions, such as magnetic resonance imaging with or without mammography, chemoprevention, or risk-reducing mastectomy and salpingo-oophorectomy, to reduce cancer risk. A total of 2000 simulations were run on 1 000 000 women, using a lifetime time horizon and payer perspective, and costs were adjusted to 2022 US dollars. This study was conducted from September 1, 2020, to December 15, 2023.Main Outcomes and MeasuresThe main outcome measure was the incremental cost-effectiveness ratio (ICER), quantified as cost per quality-adjusted life-year (QALY) gained. Secondary outcomes included incremental cost, additional breast and ovarian cancer cases prevented, and excess deaths due to coronary heart disease (CHD).ResultsThe study assessed 1 000 000 simulated women aged 30 to 35 years in the US. In the base case, population-based multigene testing was more cost-effective compared with family history–based testing, with an ICER of $55 548 per QALY (95% CI, $47 288-$65 850 per QALY). Population-based multigene testing would be able to prevent an additional 1338 cases of breast cancer and 663 cases of ovarian cancer, but it would also result in 69 cases of excess CHD and 10 excess CHD deaths per million women. The probabilistic sensitivity analyses show that the probability that population-based multigene testing is cost-effective was 100%. When the cost of the multigene test exceeded $825, population-based testing was no longer cost-effective (ICER, $100 005 per QALY; 95% CI, $87 601-$11 6323).Conclusions and RelevanceIn this economic analysis of population-based multigene testing, population-based testing was a more cost-effective strategy for the prevention of breast cancer and ovarian cancer when compared with the current family history–based testing strategy at the $100 000 per QALY willingness-to-pay threshold. These findings support the need for more comprehensive genetic testing strategies to identify pathogenic variant carriers and enable informed decision-making for personalized risk management.

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A Cost-effectiveness Analysis of Multigene Testing for All Patients With Breast Cancer

et al. 2019

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IMPORTANCE Moving to multigene testing for all women with breast cancer (BC) could identify many more mutation carriers who can benefit from precision prevention. However, the cost-effectiveness of this approach remains unaddressed. OBJECTIVE To estimate incremental lifetime effects, costs, and cost-effectiveness of multigene testing of all patients with BC compared with the current practice of genetic testing (BRCA) based on family history (FH) or clinical criteria. DESIGN, SETTING, AND PARTICIPANTS This cost-effectiveness microsimulation modeling study compared lifetime costs and effects of high-risk BRCA1/BRCA2/PALB2 (multigene) testing of all unselected patients with BC (strategy A) with BRCA1/BRCA2 testing based on FH or clinical criteria (strategy B) in United Kingdom (UK) and US populations. Data were obtained from 11 836 patients in population-based BC cohorts (regardless of FH) recruited to 4 large research studies. Data were collected and analyzed from January 1, 2018, through June 8, 2019. The time horizon is lifetime. Payer and societal perspectives are presented. Probabilistic and 1-way sensitivity analyses evaluate model uncertainty. INTERVENTIONS In strategy A, all women with BC underwent BRCA1/BRCA2/PALB2 testing. In strategy B, only women with BC fulfilling FH or clinical criteria underwent BRCA testing. Affected BRCA/PALB2 carriers could undertake contralateral preventive mastectomy; BRCA carriers could choose risk-reducing salpingo-oophorectomy (RRSO). Relatives of mutation carriers underwent cascade testing. Unaffected relative carriers could undergo magnetic resonance imaging or mammography screening, chemoprevention, or risk-reducing mastectomy for BC risk and RRSO for ovarian cancer (OC) risk. MAIN OUTCOMES AND MEASURES Incremental cost-effectiveness ratio (ICER) was calculated as incremental cost per quality-adjusted life-year (QALY) gained and compared with standard £30 000/QALY and $100 000/QALY UK and US thresholds, respectively. Incidence of OC, BC, excess deaths due to heart disease, and the overall population effects were estimated. RESULTS BRCA1/BRCA2/PALB2 multigene testing for all patients detected with BC annually would cost £10 464/QALY

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Quality of life in women at risk for ovarian cancer who have undergone risk-reducing oophorectomy

Cited by 124 publications

References 20 publications

Factors Associated with Altered Long-Term Well-Being After Prophylactic Salpingo-Oophorectomy Among Women at Increased Hereditary Risk for Breast and Ovarian Cancer

Factors Associated with Altered Long-Term Well-Being After Prophylactic Salpingo-Oophorectomy Among Women at Increased Hereditary Risk for Breast and Ovarian Cancer

Cost-Effectiveness of Population-Based Multigene Testing for Breast and Ovarian Cancer Prevention

A Cost-effectiveness Analysis of Multigene Testing for All Patients With Breast Cancer

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