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Factors influencing uptake and timing of risk reducing salpingo-oophorectomy in women at risk of familial ovarian cancer: a competing risk time to event analysis

BJOG : an international journal of obstetrics and gynaecology, 2012-04, Vol.119 (5), p.527-536 [Peer Reviewed Journal]

2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG ;2015 INIST-CNRS ;2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG. ;ISSN: 1470-0328 ;EISSN: 1471-0528 ;DOI: 10.1111/j.1471-0528.2011.03257.x ;PMID: 22260402 ;CODEN: BIOGFQ

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Title:
Factors influencing uptake and timing of risk reducing salpingo-oophorectomy in women at risk of familial ovarian cancer: a competing risk time to event analysis
Author: Manchanda, R ; Burnell, M ; Abdelraheim, A ; Johnson, M ; Sharma, A ; Benjamin, E ; Brunell, C ; Saridogan, E ; Gessler, S ; Oram, D ; Side, L ; Rosenthal, AN ; Jacobs, I ; Menon, U
Subjects: Adult ; Biological and medical sciences ; BRCA ; competing risk ; Decision making ; Early Detection of Cancer ; Female ; Female genital diseases ; Genes, BRCA1 ; Genes, BRCA2 ; Gynecology. Andrology. Obstetrics ; Health risk assessment ; Heterozygote ; Humans ; Kaplan-Meier Estimate ; Medical sciences ; Middle Aged ; Mutation - genetics ; Ovarian cancer ; Ovarian Neoplasms - genetics ; Ovarian Neoplasms - surgery ; Ovariectomy - statistics & numerical data ; Patient Acceptance of Health Care - statistics & numerical data ; Preventive medicine ; Prospective Studies ; Risk Management ; Risk Reduction Behavior ; risk-reducing salpingo-oophorectomy ; Salpingectomy - statistics & numerical data ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the genital tract and mammary gland ; Time Factors ; tubal cancer ; Tumors ; unknown mutation status
Is Part Of: BJOG : an international journal of obstetrics and gynaecology, 2012-04, Vol.119 (5), p.527-536
Description: Please cite this paper as: Manchanda R, Burnell M, Abdelraheim A, Johnson M, Sharma A, Benjamin E, Brunell C, Saridogan E, Gessler S, Oram D, Side L, Rosenthal A, Jacobs I, Menon U. Factors influencing uptake and timing of risk reducing salpingo‐oophorectomy in women at risk of familial ovarian cancer: a competing risk time to event analysis. BJOG 2012;119:527–536. Objective To evaluate factors affecting uptake of risk‐reducing salpingo‐oophorectomy (RRSO) over time in women at high‐risk of familial ovarian cancer. Design Prospective observational cohort. Setting Tertiary high‐risk familial gynaecological cancer clinic. Population/sample New clinic attendees between March 2004 and November 2009, fulfilling the high‐risk criteria for the UK Familial Ovarian Cancer Screening Study. Methods Risk management options discussed included RRSO and ovarian surveillance. Outcome data were analysed from a bespoke database. The competing risk method was used to model the cumulative incidence function (CIF) of RRSO over time, and the sub‐hazard ratio (SHR) was used to assess the strength of the association of variables of interest with RRSO. Gray’s test was used to evaluate the difference in CIF between two groups and multivariable competing risk regression analysis was used to model the cumulative probabilities of covariates on the CIF. Results Of 1133 eligible women, 265 (21.4%) opted for RRSO and 868 (69.9%) chose screening. Women undergoing RRSO were older (49 years, interquartile range 12.2 years) than those preferring screening (43.4 years, interquartile range 11.9 years) (P < 0.0005). The CIF for RRSO at 5 years was 0.55 (95% CI 0.45–0.64) for BRCA1/2 carriers and 0.22 (95% CI 0.19–0.26) for women of unknown mutation status (P < 0.0001); 0.42 (95% CI 0.36–0.47) for postmenopausal women (P < 0.0001); 0.29 (95% CI 0.25–0.33) for parity ≥1 (P = 0.009) and 0.47 (95% CI 0.39–0.55) for a personal history of breast cancer (P < 0.0001). Variables of significance from the regression analysis were: a BRCA1/2 mutation (SHR 2.31, 95% CI 1.7–3.14), postmenopausal status (SHR 2.16, 95% CI 1.62–2.87)) and a personal history of breast cancer (SHR 1.5, 95% CI 1.09–2.06). Conclusions Decision‐making is a complex process and women opt for surgery many years after initial risk assessment. BRCA carriers, postmenopausal women and women who had breast cancer are significantly more likely to opt for preventative surgery.
Publisher: Oxford, UK: Blackwell Publishing Ltd
Language: English
Identifier: ISSN: 1470-0328
EISSN: 1471-0528
DOI: 10.1111/j.1471-0528.2011.03257.x
PMID: 22260402
CODEN: BIOGFQ
Source: MEDLINE
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Factors influencing uptake and timing of risk reducing salpingo-oophorectomy in women at risk of familial ovarian cancer: a competing risk time to event analysis

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