Prophylactic salpingectomy and delayed oophorectomy as an alternative for BRCA mutation carriers.

Authors:
Janice S Kwon
Janice S Kwon
University of British Columbia and British Columbia Cancer Agency
Anna Tinker
Anna Tinker
University of British Columbia
Canada
Gary Pansegrau
Gary Pansegrau
University of British Columbia and BC Cancer Agency
Canada
Melissa Housty
Melissa Housty
University of British Columbia and BC Cancer Agency
Canada
Mary McCullum
Mary McCullum
University of British Columbia
Canada

Obstet Gynecol 2013 Jan;121(1):14-24

University of British Columbia and BC Cancer Agency, Vancouver, British Columbia, Canada.

Objective: Prophylactic bilateral salpingo-oophorectomy is advised for women with BRCA mutations, but there are adverse consequences of premature menopause. The majority of BRCA-associated ovarian cancers appear to arise in the fallopian tube; therefore, salpingectomy may be an alternative to bilateral salpingo-oophorectomy. We compared the costs and benefits of salpingectomy with bilateral salpingo-oophorectomy among BRCA mutation carriers.

Methods: We developed a Markov Monte Carlo simulation model to compare three strategies for risk reduction in women with BRCA mutations: 1) bilateral salpingo-oophorectomy; 2) bilateral salpingectomy; and 3) bilateral salpingectomy with delayed oophorectomy. Net health benefits were measured in years-of-life expectancy and quality-adjusted life-year expectancy, and the primary outcome was the incremental cost-effectiveness ratio. The model estimated the number of future breast and ovarian cancers and cardiovascular deaths attributed to premature menopause with each strategy.

Results: Bilateral salpingo-oophorectomy was associated with the lowest cost and highest life expectancy compared with the other two strategies. When quality-of-life measures were included, salpingectomy followed by delayed oophorectomy yielded the highest quality-adjusted life expectancy with incremental cost-effectiveness ratios of $37,805 and $89,680 per quality-adjusted life-year for BRCA1 and BRCA2, respectively, relative to salpingectomy alone. Bilateral salpingo-oophorectomy yielded the lowest number of future breast and ovarian cancers compared with the other two strategies.

Conclusion: Bilateral salpingo-oophorectomy offers the greatest risk reduction for breast and ovarian cancer among BRCA mutation carriers. However, when considering quality-adjusted life expectancy, bilateral salpingectomy with delayed oophorectomy is a cost-effective strategy and may be an acceptable alternative for those unwilling to undergo bilateral salpingo-oophorectomy.

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http://dx.doi.org/http://10.1097/AOG.0b013e3182783c2fDOI Listing
January 2013
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