Decision-making surrounding ovarian cancer risk-reducing surgery: perspectives from a diverse population

OBJECTIVE: Individuals with BRCA1/2 pathogenic variants (PV) are recommended risk-reducing salpingo-oophorectomy between 35 and 45 years of age to prevent ovarian cancer. Trials evaluating the oncologic safety of risk-reducing salpingectomy are ongoing. One's decision on the type and timing of surgery has implications for fertility, quality of life, and long-term health. Published literature on patient preferences has focused on White women from North America and Europe; thus, findings are not necessarily generalizable to patients from other backgrounds. To address this gap, we sought to assess decision-making around ovarian cancer risk-reducing surgery among a racially and ethnically diverse population with BRCA1/2 PVs. METHODS: Between February 2023 and November 2023, patients with BRCA1/2 PVs were invited to participate in a one-time, semi-structured, one-on-one interview. Interviews were recorded, transcribed, and analyzed using an inductive approach by two independent coders. RESULTS: Among 15 participants, the median age was 41 years (range 24-64). Ten participants identified as Hispanic, Black, or Asian. Two identified as gender queer. Six had a history of breast cancer. Ten had undergone risk-reducing surgery for ovarian cancer (seven salpingo-oophorectomy and three salpingectomy). Concerns about surgical menopause were a primary consideration for all participants. Other influencing factors included fertility, oncologic safety, history of breast cancer, sexual function, sense of control, gender identity, and mental health. CONCLUSION: This study identified themes that influenced decision-making among BRCA1/2 PV carriers considering or having undergone risk-reducing gynecologic surgery in a racially and ethnically diverse population. These insights can help clinicians better support patients undergoing this process, with the objective of providing patient-centered, culturally sensitive care.