Specifying the ovarian cancer risk threshold of ‘premenopausal risk-reducing salpingo-oophorectomy’ for ovarian cancer prevention: a cost-effectiveness analysis

Manchanda, Ranjit; Legood, Rosa; Antoniou, Antonis C.; Gordeev, Vladimir Sergeevich; Menon, Usha

doi:10.1136/jmedgenet-2016-103800

Cited by 68 publications

(55 citation statements)

References 55 publications

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“…Whereas cost-effectiveness of RRSO in BRCA1/BRCA2 carriers who are older than 35 and have completed their families is well established, 28 the cost-effectiveness at lower levels of risk was only recently reported. We developed decision analytic models to identify the ovarian cancer risk thresholds, which would be appropriate for RRSO-based primary surgical prevention in both premenopausal 29 and postmenopausal women. 30 Decision modeling provides a logical, quantitative, and transparent framework for evaluating costs and consequences (health outcomes), which result from a sequence of events following alternative treatment strategies.…”

Section: Risk-reducing Salpingo-oophorectomymentioning

confidence: 99%

Setting the Threshold for Surgical Prevention in Women at Increased Risk of Ovarian Cancer

Manchanda

Menon

2018

Int J Gynecol Cancer

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The number of ovarian cancer cases is predicted to rise by 14% in Europe and 55% worldwide over the next 2 decades. The current absence of a screening program, rising drug/treatment costs, and only marginal improvements in survival seen over the past 30 years suggest the need for maximizing primary surgical prevention to reduce the burden of ovarian cancer. Primary surgical prevention through risk-reducing salpingo-oophorectomy (RRSO) is well established as the most effective method for preventing ovarian cancer. In the UK, it has traditionally been offered to high-risk women (>10% lifetime risk of ovarian cancer) who have completed their family. The cost-effectiveness of RRSO in BRCA1/BRCA2 carriers older than 35 years is well established. Recently, RRSO has been shown to be cost-effective in postmenopausal women at lifetime ovarian cancer risks of 5% or greater and in premenopausal women at lifetime risks greater than 4%. The acceptability, uptake, and satisfaction with RRSO at these intermediate-risk levels remain to be established. Prospective outcome data on risk-reducing salpingectomy and delayed-oophorectomy for preventing ovarian cancer is lacking, and hence, this is best offered for primary prevention within the context and safe environment of a clinical trial. An estimated 63% of ovarian cancers occur in women with greater than 4% lifetime risk and 53% in those with 5% or greater lifetime-risk. Risk-reducing salpingo-oophorectomy can be offered for primary surgical prevention to women at intermediate risk levels (4%-5% to 10%). This includes unaffected women who have completed their family and have RAD51C, RAD51D, or BRIP1 gene mutations; first-degree relatives of women with invasive epithelial ovarian cancer; BRCA mutation-negative women from high-risk breast-and-ovarian cancer or ovarian-cancer-only families. In those with BRCA1, RAD51C/RAD51D/MMR mutations and the occasional families with a history of ovarian cancer in their 40s, surgery needs to be considered at younger than 45. In other moderate-risk gene mutation carriers and those with polygenic risk, RRSO needs be considered at 50. There is need for establishment/expansion of well-defined pathways to increase clinical access to RRSO. It is time to lower the risk threshold for RRSO to enable introduction of a targeted primary prevention approach, which could significantly impact the future burden of ovarian cancer.

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Section: Risk-reducing Salpingo-oophorectomymentioning

confidence: 99%

Setting the Threshold for Surgical Prevention in Women at Increased Risk of Ovarian Cancer

Manchanda

Menon

2018

Int J Gynecol Cancer

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“…However, given the current lack of mortality benefit from ovarian cancer screening, BSO may be considered for women at lower risks associated with moderate‐penetrance genes . Furthermore, BSO has been shown to be cost‐effective at ≥4% lifetime risk of ovarian cancer . Developments in our understanding of the pathogenesis of ovarian cancer may provide other options for prevention.…”

Section: Genetic Basis Of Ovarian Cancermentioning

confidence: 99%

“…10 Furthermore, BSO has been shown to be cost-effective at ≥4% lifetime risk of ovarian cancer. 17 Developments in our understanding of the pathogenesis of ovarian cancer may provide other options for prevention. Bilateral salpingectomy followed by delayed oophorectomy is being considered as an alternative to BSO.…”

mentioning

confidence: 99%

Moving towards population‐based genetic risk prediction for ovarian cancer

Rahman

Side

Gibbon

et al. 2017

BJOG

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“…Surgical prevention has been shown to be cost-effective at the 5-10% ovarian cancer risk thresholds (Manchanda, Legood, Antoniou, Gordeev, & Menon, 2016;Manchanda, Legood, et al, 2015). Newer risk models and recently validated intermediate risk genes can identify individuals at these risk thresholds.…”

Section: Introductionmentioning

confidence: 99%

Women’s intentions to engage in risk-reducing behaviours after receiving personal ovarian cancer risk information: an experimental survey study

Gallagher¹,

Waller²,

Manchanda³

et al. 2019

Preprint

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Risk stratification using genetic and/or other types of information could identify women at increased ovarian cancer risk. The aim of this study was to examine women’s potential reactions to ovarian cancer risk stratification. 1,017 women aged 45-75 years took part in an online experimental survey. Women were randomly assigned to one of three experimental conditions describing hypothetical personal results from ovarian cancer risk stratification, and asked to imagine they had received one of three results: (a) 5% risk due to SNPs and lifestyle factors; (b) 10% risk due to SNPs and lifestyle factors; (c) 10% risk due to a rare mutation in BRCA2. 83% of women indicated interest in having ovarian cancer risk assessment. After receiving their hypothetical risk estimates, 29% of women stated they would have risk-reducing surgery. Choosing risk-reducing surgery over other behavioural responses was associated with having higher surgery self-efficacy and perceived response-efficacy, but not with perceptions of disease threat, i.e. perceived risk or severity, or with experimental condition. A substantial proportion of women age 45-75 years may be open to the idea of surgery to reduce risk of ovarian cancer, even if their absolute lifetime risk is only increased to as little as 5 or 10%.

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Specifying the ovarian cancer risk threshold of ‘premenopausal risk-reducing salpingo-oophorectomy’ for ovarian cancer prevention: a cost-effectiveness analysis

Cited by 68 publications

References 55 publications

Setting the Threshold for Surgical Prevention in Women at Increased Risk of Ovarian Cancer

Setting the Threshold for Surgical Prevention in Women at Increased Risk of Ovarian Cancer

Moving towards population‐based genetic risk prediction for ovarian cancer

Women’s intentions to engage in risk-reducing behaviours after receiving personal ovarian cancer risk information: an experimental survey study

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