De besluitvorming rondom preventieve bilaterale salpingo-oöphorectomie

Introduction Women who carry BRCA1/2 mutations have an increased risk for breast and ovarian cancer. They can choose these management options: screening or preventive surgery. Ovarian screening turned out to be ineffective. The only option to avoid death by ovarian cancer is prophylactic bilateral salpingo-oophorectomy (pBSO). Breast screening is effective for early detection of malignancy, for which early treatment leads to a good prognosis. Prophylactic mastectomy (PM) with or without breast reconstruction is another option. Aim of the study This study focuses on the considerations which are crucial in making and planning the decision for pBSO. Our aim was to gain more insight into the underlying thoughts and arguments of the patient, in order to improve education and counseling. This study consisted of two parts: a retrospective database analysis, followed by semi-structured interviews. Results In case of pBSO, women were generally older. They were more likely to have a proven mutation, a greater number of children of an older age and no childbearing aspirations, influenced by their own age. They often had previous breast cancer and family members of the same or younger generation (sister, daughter, cousin) with breast and/or ovarian cancer. Least important factors were communication with third parties and other information sources. pBSO was often chosen due to the lack of effective screening for and the poor prognosis of ovarian cancer, but was delayed until older age after childbearing is complete (in accordance with hospital policy). Conclusions During the process of decision making for pBSO, many factors play a part. A proven mutation, age, childbearing and previous experiences influence the fear of cancer and self-estimated risks. Women with previous breast cancer have a primary need for information on being a mutation carrier, ovarian cancer and management options following their earlier therapy. Women without breast cancer do have a need for general information regarding both cancers. Graphs showing the penetrance and age spread of ovarian cancer can help visualise and explain the advised age of 35-40 (BRCA1) or 40-45 years (BRCA2) for pBSO.