Researchers Suggest Lowering Guildelines for Pre-emptive Surgery Against Ovarian Cancer

Researchers Suggest Lowering Guildelines for Pre-emptive Surgery Against Ovarian Cancer

UK researchers have recently suggested that the current guidelines for women to receive risk-reducing salpingo-oophorectomy (RRSO) should be re-evaluated in order to allow the cost-effective and lifesaving procedure for women with as little as 4 percent lifetime risk of developing ovarian cancer (OC).

The study, “Specifying the ovarian cancer risk threshold of ‘premenopausal risk-reducing salpingo-oophorectomy’ for ovarian cancer prevention: a cost-effectiveness analysis,” was published in the latest online edition of the Journal of Medical Genetics.

About Risk-Reducing Salpingo-Oophorectomy

RRSO is the surgical removal of the ovaries and fallopian tubes to prevent ovarian cancer for women typically at high risk due to hereditary, possessing the BRCA1 or BRCA2 gene mutations, or other reasons.

Clinically, this procedure is the most effective intervention against ovarian cancer and is currently only recommended for premenopausal women with a greater than 10% lifetime risk of developing ovarian cancer.

About this Study

To assess the cost-effectiveness of RRSO as a pre-emptive strike against ovarian cancer, the research team analyzed lifetime costs and health impacts of RRSO with 40-year-old premenopausal women, then compared findings to a similar patient population in which the procedure was not performed but who were at risk levels from 2 percent to 10 percent.

Data from sources that included the Nurses Health Study, British National Formulary, Cancer Research UK, National Institute for Health and Care Excellence guidelines, and National Health Service was used to glean reference costs.  Measurable variables for cost-effectiveness and health impact included diagnosis of ovarian cancer, breast cancer (BC) and deaths from coronary heart disease.  Total costs and effects arrived at via an equation that estimates timeline of good health in individual patients and populations, the incidence of ovarian and breast cancers, and the results of an equation used to determine the cost-effectiveness of health care intervention were also utilized.

Findings showed that premenopausal RRSO was highly cost-effective in women with 4 percent lifetime ovarian cancer risk, with a greater to equal increase of 42.7 days in life expectancy if the patient complied with hormone replacement therapy recommendations.

Other important findings showed that the benefits were largely driven by reduction in breast cancer risk; and that RRSO remains cost-effective at greater than 8.2 percent ovarian cancer risk without hormone replacement therapy.

Study authors wrote: “Our results are of major significance for clinical practice and risk management in view of declining genetic testing costs and the improvements in estimating an individual’s ovarian cancer risk.”

Researchers concluded that in the absence of an effective ovarian cancer screening program, the findings provided evidence supporting a surgical prevention strategy for low risk women.