New surgical approach for women at risk of ovarian cancer

Date:
August 24, 2020
Source:
Queen Mary University of London
Summary:
A new two-stage surgical approach for cancer prevention is highly
acceptable among premenopausal women at high risk of ovarian cancer.



FULL STORY ==========================================================================
A new two-stage surgical approach for cancer prevention is highly
acceptable among premenopausal women at high risk of ovarian cancer,
according to research led by Queen Mary University of London.


==========================================================================
For women at high risk of ovarian cancer, the standard preventive
practice is to offer removal of both the fallopian tubes and ovaries,
but the surgery induces menopause in women who have not yet reached this
stage of life. Early menopause is associated with side effects like
increased risk of heart-disease, osteoporosis, neurocognitive decline
and sexual-dysfunction. Hence, some women at high risk of ovarian cancer
delay surgery until after they reach menopause.

During this period they remain at much higher risk of ovarian cancer.

A proposed alternative is a two-step surgical protocol, which delays the induced menopause caused by the removal of the ovaries. In this protocol,
the fallopian tubes are removed as an initial step to offer some risk reduction, and ovary removal is delayed until a later stage when women
have reached menopause. This procedure provides some ovarian cancer
risk reduction while avoiding detrimental consequences of premature surgically-induced menopause.

69 per cent interested in new surgical option In the multicentre UK
study, published in the British Journal of Obstetrics and Gynaecology and funded by the Rosetrees Trust and Barts Charity, researchers examined the acceptability of the proposed alternative two-step surgical protocol. The
638 study participants were all at increased risk of ovarian cancer;
346 had undergone standard risk reducing surgery, and 337 had not.

Among those who had undergone standard preventive surgery, 9.4 per cent
of premenopausal and 1.2 per cent of postmenopausal women regretted their decision. Of premenopausal women who had not undergone standard surgery,
69 per cent found it acceptable to participate in a research study
offering the proposed new surgical option. 38 per cent of women who had undergone standard surgery would have potentially (in hindsight) opted
for the new two-step operation. The new two-step surgical protocol was particularly acceptable to women concerned about the sexual dysfunction
side effects of ovary removal.



========================================================================== Patients sought for clinical trial into new surgery protocol Lead
researcher Professor Ranjit Manchanda from Queen Mary University of
London and Barts Health NHS Trust said: "Undergoing an operation to
prevent ovarian cancer can be a complex decision making process. Although removal of tubes and ovaries prevents ovarian cancer, it can lead to
early surgical menopause which has significant detrimental consequences
on long-term health. A number of women opt to delay or decline preventive surgery as a result.

"The new two-step operation offers additional options for women (who may
have not undergone surgical prevention) to reduce their ovarian cancer
risk while avoiding the negative impact of early menopause. Our study
shows a large proportion of eligible women wish to consider this. UK
women who wish to do so now have the option of joining the PROTECTOR (Preventing Ovarian Cancer through early Excision of Tubes and late
Ovarian Removal) study." Dr Faiza Gaba from Queen Mary University of
London added: "While hormone replacement therapy (HRT) has been shown to mitigate some symptoms, it does not appear to alleviate sexual-dysfunction
or increase satisfaction levels following standard preventive surgery
involving removal of ovaries. However HRT-use in breast cancer unaffected
women undergoing premenopausal removal of their ovaries is essential
to reduce the risk of heart disease, osteoporosis and neurocognitive
decline. The new two-step surgery offers further options to women
considering surgical prevention." Treatments designed around women's individual needs and choices Dr Vineeth Rajkumar, Head of Research at
Rosetrees Trust said: "Rosetrees Trust is delighted to have supported
Professor Manchanda's study, which has paved the way for a clinical trial
that could make a difference to thousands of women at risk of ovarian
cancer." Victoria King, Director of Grants at Barts Charity added:
"Barts Charity is proud to support the PROTECTOR trial, a trial which
could make a huge difference to women with increased risk of ovarian
cancer. It is hugely important to us that it carries the potential for
better informed decision- making for women themselves and treatments
designed around women's individual needs and choices."

========================================================================== Story Source: Materials provided by Queen_Mary_University_of_London. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. F Gaba, O Blyuss, D Chandrasekaran, M Osman, S Goyal, C Gan,
L Izatt, V
Tripathi, I Esteban, L McNicol, K Ragupathy, R Crawford, DG Evans,
R Legood, U Menon, R Manchanda. Attitudes towards risk - reducing
early salpingectomy with delayed oophorectomy for ovarian cancer
prevention: a cohort study. British Journal of Obstetrics and
Gynaecology, 2020 DOI: 10.1111/1471-0528.16424 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/08/200824105555.htm

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