Multicenter prospective trial of patient-centered approach to surgical prevention of ovarian cancer

Risk-reducing salpingo-oophorectomy (RRSO) is an effective option to prevent ovarian cancer in high-risk individuals, but adverse effects from premature menopause are a barrier to uptake. Interval salpingectomy with delayed oophorectomy (ISDO) may be an effective alternative. A prospective, nonrandomized (patient preference) clinical trial at 9 US centers evaluated the association of ISDO versus RRSO with sexual function and menopausal symptoms among patients with pathogenic or likely pathogenic germline variants conferring an increased risk for ovarian cancer. The analytic sample included 334 participants (mean age at consent 39.2 years) who underwent RRSSO (n=165) or ISDO (n=169) and completed 6-month questionnaires. Significantly more participant experienced clinically meaningful worsening of sexual function at 6 months compared to baseline after RRSO versus ISDO (33.1% versus 16.8%; OR 2.00; 95% 1.20-3.35), which was also significant at 12 months (39.2% versus 18.3%; 1.69; 1.09-2.63), but no longer significant at 24 months. When restricted to the RRSO group who took hormone replacement therapy, there was no significant worsening of total sexual function scores or menopausal symptoms compared with baseline. No interval ovarian cancers were reported. The authors conclude that the trial found that ISDO versus RRSO was less likely to impair sexual function, which addresses an important barriers to surgical prevention in high-risk patients in premenopause.