Risk-reducing salpingo-oophorectomy: a meta-analysis on impact on ovarian cancer risk and all cause mortality in BRCA 1 and BRCA 2 mutation carriers

e13051 Background: Cost-effectiveness analysis is important in healthcare, especially in Japan, where preventive measures for carriers of BRCA 1/2 mutations are not covered by health insurance. Methods: We developed Markov models in a simulated cohort of women aged 35–70, and compared outcomes of surveillance with risk-reducing mastectomy at age 35 (RRM), risk-reducing salpingo-oophorectomy at age 45 (RRSO), and both (RRM&RRSO), with quality adjustment. We used breast and ovarian cancer incidence, and adverse event rates from previous studies, adjuvant chemotherapy and hormonal therapy rates from Hereditary Breast and Ovarian Cancer Registration 2015, mortality rates from the National Cancer Center Hospital, Japan Society of Clinical Oncology and Ministry of Health, Labour and Welfare, and direct costs in 2016 Japanese yen from St. Luke’s International Hospital and Keio University Hospital. We used preference ratings for both of mutation carriers and controls (without known high risk) from a published study to adjust survival for quality of life (QALYs). Discount rate was 2%. Results: Compared with surveillance, RRSO and RRM & RRSO were dominant (cost-saving and more effective) and RRM was cost effective for BRCA 1 mutation carriers. RRM and RRM & RRSO were dominant, and RRSO was cost effective for BRCA 2 mutation carriers. Among four strategies including surveillance, RRM & RRSO was the most cost effective for BRCA 1 mutation carriers and RRM was the most cost effective for BRCA 2 mutation carriers based on preference ratings of controls. Conclusions: With quality adjustment, all the preventive strategies (RRM, RRSO and RRM&RRSO) were cost effective for BRCA 1 and 2. Using QALYs from the control group, RRM & RRSO for BRCA 1 and RRM for BRCA 2 were the most cost effective. We will use this result to promote insurance coverage for BRCA mutations carriers in Japan.

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A common SNP in the UNG gene decreases ovarian cancer risk in BRCA 2 mutation carriers

Molecular Oncology ◽

10.1002/1878-0261.12470 ◽

2019 ◽

Vol 13 (5) ◽

pp. 1110-1120 ◽

Cited By ~ 2

Author(s):

Juan Miguel Baquero ◽

Carlos Benítez‐Buelga ◽

Victoria Fernández ◽

Miguel Urioste ◽

Jose Luis García‐Giménez ◽

...

Keyword(s):

Ovarian Cancer ◽

Cancer Risk ◽

Ovarian Cancer Risk ◽

Mutation Carriers ◽

Brca 2

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Oral Contraceptives and Risk of Ovarian Cancer and Breast Cancer Among High-Risk Women: A Systematic Review and Meta-Analysis

Journal of Clinical Oncology ◽

10.1200/jco.2013.48.9021 ◽

2013 ◽

Vol 31 (33) ◽

pp. 4188-4198 ◽

Cited By ~ 138

Author(s):

Patricia G. Moorman ◽

Laura J. Havrilesky ◽

Jennifer M. Gierisch ◽

Remy R. Coeytaux ◽

William J. Lowery ◽

...

Keyword(s):

Breast Cancer ◽

Ovarian Cancer ◽

Family History ◽

Cancer Risk ◽

Meta Analysis ◽

Brca2 Mutation ◽

Ovarian Cancer Risk ◽

Mutation Carriers ◽

History Of ◽

Meta Analyses

Purpose To estimate the risks of ovarian cancer and breast cancer associated with oral contraceptive (OC) use among women at elevated risk owing to mutations in BRCA1/2 or a strong family history. Methods We searched PubMed, Embase, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov for studies published 2000 to 2012 that evaluated associations between OC use and breast or ovarian cancer among women who are carriers of a BRCA1/2 mutation or have a family history of breast or ovarian cancer. Results From 6,476 unique citations, we identified six studies examining ovarian cancer risk in BRCA1/2 mutation carriers and eight studies examining breast cancer risk in BRCA1/2 mutation carriers. For BRCA1/2 mutation carriers combined, meta-analysis showed an inverse association between OC use and ovarian cancer (odds ratio [OR], 0.58; 95% CI, 0.46 to 0.73) and a nonstatistically significant association with breast cancer (OR, 1.21; 95% CI, 0.93 to 1.58). Findings were similar when examining BRCA1 and BRCA2 mutation carriers separately. Data were inadequate to perform meta-analyses examining duration or timing of use. For women with a family history of ovarian or breast cancer, we identified four studies examining risk for ovarian cancer and three for breast cancer, but differences between studies precluded combining the data for meta-analyses, and no overall pattern could be discerned. Conclusion Our analyses suggest that associations between ever use of OCs and ovarian and breast cancer among women who are BRCA1 or BRCA2 mutation carriers are similar to those reported for the general population.

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Oral contraceptive use and ovarian cancer risk for BRCA1/2 mutation carriers: an international cohort study

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2021.01.014 ◽

2021 ◽

Author(s):

Lieske H. Schrijver ◽

Antonis C. Antoniou ◽

Håkan Olsson ◽

Thea M. Mooij ◽

Marie-José Roos-Blom ◽

...

Keyword(s):

Ovarian Cancer ◽

Cohort Study ◽

Oral Contraceptive ◽

Cancer Risk ◽

Contraceptive Use ◽

Ovarian Cancer Risk ◽

Oral Contraceptive Use ◽

Mutation Carriers

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Dietary Inflammatory Index and Ovarian Cancer Risk: A Meta-Analysis

Nutrition and Cancer ◽

10.1080/01635581.2021.1931366 ◽

2021 ◽

pp. 1-10

Author(s):

Jiani Yang ◽

Jun Ma ◽

Yue Jin ◽

Shanshan Cheng ◽

Shan Huang ◽

...

Keyword(s):

Ovarian Cancer ◽

Cancer Risk ◽

Meta Analysis ◽

Ovarian Cancer Risk ◽

Dietary Inflammatory Index ◽

Inflammatory Index

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Predictors of risk-reducing surgery intentions following genetic counseling for hereditary breast and ovarian cancer

Translational Behavioral Medicine ◽

10.1093/tbm/iby101 ◽

2018 ◽

Vol 10 (2) ◽

pp. 337-346 ◽

Cited By ~ 3

Author(s):

Mary Kathleen Ladd ◽

Beth N Peshkin ◽

Leigha Senter ◽

Shari Baldinger ◽

Claudine Isaacs ◽

...

Keyword(s):

Breast Cancer ◽

Ovarian Cancer ◽

Genetic Counseling ◽

Cancer Risk ◽

Prophylactic Surgery ◽

Ovarian Cancer Risk ◽

Breast And Ovarian Cancer ◽

Affective Factors ◽

Risk Reducing

Abstract Risk-reducing mastectomy (RRM) and salpingo-oophorectomy (RRSO) are increasingly used to reduce breast and ovarian cancer risk following BRCA1/BRCA2 testing. However, little is known about how genetic counseling influences decisions about these surgeries. Although previous studies have examined intentions prior to counseling, few have examined RRM and RRSO intentions in the critical window between genetic counseling and test result disclosure. Previous research has indicated that intentions at this time point predict subsequent uptake of surgery, suggesting that much decision-making has taken place prior to result disclosure. This period may be a critical time to better understand the drivers of prophylactic surgery intentions. The aim of this study was to examine predictors of RRM and RRSO intentions. We hypothesized that variables from the Health Belief Model would predict intentions, and we also examined the role of affective factors. Participants were 187 women, age 21–75, who received genetic counseling for hereditary breast and ovarian cancer. We utilized multiple logistic regression to identify independent predictors of intentions. 49.2% and 61.3% of participants reported intentions for RRM and RRSO, respectively. Variables associated with RRM intentions include: newly diagnosed with breast cancer (OR = 3.63, 95% CI = 1.20–11.04), perceived breast cancer risk (OR = 1.46, 95% CI = 1.17–1.81), perceived pros (OR = 1.79, 95% CI = 1.38–2.32) and cons of RRM (OR = 0.81, 95% CI = 0.65–0.996), and decision conflict (OR = 0.80, 95% CI = 0.66–0.98). Variables associated with RRSO intentions include: proband status (OR = 0.28, 95% CI = 0.09–0.89), perceived pros (OR = 1.35, 95% CI = 1.11–1.63) and cons of RRSO (OR = 0.72, 95% CI = 0.59–0.89), and ambiguity aversion (OR = 0.79, 95% CI = 0.65–0.95). These data provide support for the role of genetic counseling in fostering informed decisions about risk management, and suggest that the role of uncertainty should be explored further.

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Circulating Insulin-Like Growth Factor-1 Level and Ovarian Cancer Risk

Cellular Physiology and Biochemistry ◽

10.1159/000438652 ◽

2016 ◽

Vol 38 (2) ◽

pp. 589-597 ◽

Cited By ~ 12

Author(s):

Yiyang Li ◽

Yang Li ◽

Jialing Zhang ◽

Changjun Zheng ◽

He Zhu ◽

...

Keyword(s):

Ovarian Cancer ◽

Growth Factor ◽

Cancer Risk ◽

Confidence Interval ◽

Odds Ratio ◽

Meta Analysis ◽

Epidemiological Studies ◽

Ovarian Cancer Risk ◽

Insulin Like Growth Factor ◽

Summary Odds Ratio

Background/Aims: Insulin-like growth factor-1 (IGF-1) has an important role in cells' proliferation, differentiation and apoptosis, and it may be involved in carcinogenesis. Several epidemiological studies assessed the association between circulating IGF-1 level and ovarian cancer risk, but there was still no conclusive finding. Methods: A meta-analysis of published studies was performed to assess the association between circulating IGF-1 level and ovarian cancer risk. The summary odds ratio (OR) with 95% confidence interval (95%CI) was calculated through meta-analysis to evaluate the strength of the association. Results: Five eligible studies were included into the meta-analysis, which involved a total of 2,028 cases of ovarian cancer and 4,625 controls. Meta-analysis of total 5 studies showed that high circulating IGF-1 level was correlated with decreased risk of ovarian cancer (OR = 0.84, 95%CI 0.74-0.97, P = 0.013). After adjusting for heterogeneity, high circulating IGF-1 level was still correlated with decreased risk of ovarian cancer (OR = 0.83, 95%CI 0.72-0.95, P = 0.007). Subgroup analysis by age showed that circulating IGF-1 level was not correlated with ovarian cancer risk in women both less than 55 years and more than 55 years. However, after adjusting for heterogeneity, high circulating IGF-1 level was correlated with decreased ovarian cancer risk in women less than 55 years (OR = 0.82, 95%CI 0.72-0.94, P = 0.004). Conclusion: Our meta-analysis suggests that high circulating IGF-1 level may be correlated with decreased ovarian cancer risk, especially in women less than 55 years. More studies are needed to further assess the association between circulating IGF-1 level and ovarian cancer risk in the future.

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

10.31234/osf.io/jqu87 ◽

2019 ◽

Author(s):

Ailish Gallagher ◽

Jo Waller ◽

Ranjit Manchanda ◽

Ian Jacobs ◽

Saskia Sanderson

Keyword(s):

Ovarian Cancer ◽

Cancer Risk ◽

Risk Stratification ◽

Perceived Risk ◽

Lifestyle Factors ◽

Cancer Risk Assessment ◽

Survey Study ◽

Ovarian Cancer Risk ◽

Risk Reducing ◽

Experimental Survey

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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