Our Summary

This research paper explores why women in Malaysia who carry a particular genetic mutation (BRCA) that increases the risk of ovarian cancer, might choose not to undergo a preventative surgery (Risk-Reducing Salpingo-Oophorectomy or RRSO) that greatly reduces this risk. Interviews with 28 women who carry this mutation and have a history of breast cancer, were conducted.

The study found that their decision-making process is influenced by several factors. These include their understanding of the risk they face, their desire to protect their own health, their responsibilities as mothers, and the importance they place on their marriages. Many women were worried that the surgery would impact their ability to care for their children and some felt they needed to have the surgery for the sake of their children. For others, the support of their husbands was crucial, with concerns about the impact of the surgery on their emotional health and sex lives.

Even though some women were hesitant about the surgery, their decisions often evolved as their life situations changed. The study concludes that recognizing these factors during clinical consultations can help support these women in their decision-making process.

FAQs

  1. What factors influence the decision-making process of women in Malaysia with the BRCA mutation regarding the Risk-Reducing Salpingo-Oophorectomy (RRSO)?
  2. How does the role of motherhood and marriage impact the decision of these women in undergoing Risk-Reducing Salpingo-Oophorectomy (RRSO)?
  3. How can understanding these factors help clinicians in supporting these women in their decision-making process about the surgery?

Doctor’s Tip

A doctor might tell a patient considering salpingo-oophorectomy that it is important to thoroughly discuss and consider all factors that may influence their decision, including their understanding of the risks involved, their responsibilities as a mother, and the support of their spouse. It is important to weigh the potential benefits of the surgery in reducing the risk of ovarian cancer against any concerns or fears the patient may have. Additionally, it is important to recognize that decision-making may evolve over time as life circumstances change, and to continue to have open and honest discussions with healthcare providers to support the patient in making the best decision for their health.

Suitable For

Salpingo-oophorectomy is typically recommended for patients who are at high risk of developing ovarian cancer, such as those with a family history of ovarian cancer, a personal history of breast cancer, or carrying certain genetic mutations such as BRCA1 or BRCA2. Women who have completed childbearing and are at high risk for ovarian cancer may also be recommended for salpingo-oophorectomy.

In the case of the study mentioned above, women with a history of breast cancer who also carry the BRCA genetic mutation are at an increased risk of developing ovarian cancer. These women may be recommended for risk-reducing salpingo-oophorectomy to reduce their risk of developing ovarian cancer. However, as the study found, the decision to undergo this surgery is influenced by various factors such as understanding of the risk, desire to protect their health, responsibilities as mothers, and the importance of their marriages.

Ultimately, each patient’s decision to undergo salpingo-oophorectomy should be individualized and based on a thorough discussion with their healthcare provider about their personal risk factors, goals, and concerns.

Timeline

Before Salpingo-Oophorectomy:

  1. Women are diagnosed with a genetic mutation (BRCA) that increases the risk of ovarian cancer.
  2. Women undergo genetic counseling to understand their risk and options for risk-reducing surgery.
  3. Women may have a history of breast cancer, further increasing their risk.
  4. Women consider the potential impact of surgery on their health, responsibilities as mothers, and relationships.

After Salpingo-Oophorectomy:

  1. Women undergo Risk-Reducing Salpingo-Oophorectomy (RRSO) to reduce their risk of ovarian cancer.
  2. Some women may have concerns about the impact of surgery on their ability to care for their children.
  3. Support from spouses and healthcare providers plays a crucial role in decision-making.
  4. Women’s decisions may evolve as their life situations change, such as their children growing older or their emotional health.
  5. Recognizing these factors during clinical consultations can help support women in their decision-making process.

What to Ask Your Doctor

Some questions a patient should ask their doctor about salpingo-oophorectomy include:

  1. What is the purpose of a salpingo-oophorectomy and how does it reduce the risk of ovarian cancer?
  2. What are the potential risks and complications associated with the surgery?
  3. How will the surgery impact my future fertility and menopausal symptoms?
  4. Are there alternative risk-reducing strategies or treatments available?
  5. How will the surgery affect my overall health and quality of life?
  6. What is the recommended timing for the surgery and how long is the recovery period?
  7. How often will I need follow-up screenings or monitoring after the surgery?
  8. How will the surgery impact my relationships, including my role as a mother and partner?
  9. What support resources are available for me before, during, and after the surgery?
  10. Can you provide more information about the genetic mutation (BRCA) and how it affects my risk of ovarian cancer?

Reference

Authors: Sa’at H, Lee YK, Yoon SY, Wong SW, Woo YL, Barlow-Stewart K, Mohd Taib NA. Journal: Int J Behav Med. 2022 Feb;29(1):1-13. doi: 10.1007/s12529-021-09984-y. Epub 2021 Mar 31. PMID: 33791992