Prophylactic salpingectomy and delayed oophorectomy as an alternative for BRCA mutation carriers.

Abstract

OBJECTIVE:

Prophylactic bilateral salpingo-oophorectomy is advised for women with BRCA mutations, but there are adverse consequences of premature menopause. The majority of BRCA-associated ovarian cancers appear to arise in the fallopian tube; therefore, salpingectomy may be an alternative to bilateral salpingo-oophorectomy. We compared the costs and benefits of salpingectomy with bilateral salpingo-oophorectomy among BRCA mutation carriers.

METHODS:

We developed a Markov Monte Carlo simulation model to compare three strategies for risk reduction in women with BRCA mutations: 1) bilateral salpingo-oophorectomy; 2) bilateral salpingectomy; and 3) bilateral salpingectomy with delayed oophorectomy. Net health benefits were measured in years-of-life expectancy and quality-adjusted life-year expectancy, and the primary outcome was the incremental cost-effectiveness ratio. The model estimated the number of future breast and ovarian cancers and cardiovascular deaths attributed to premature menopause with each strategy.

RESULTS:

Bilateral salpingo-oophorectomy was associated with the lowest cost and highest life expectancy compared with the other two strategies. When quality-of-life measures were included, salpingectomy followed by delayed oophorectomy yielded the highest quality-adjusted life expectancy with incremental cost-effectiveness ratios of $37,805 and $89,680 per quality-adjusted life-year for BRCA1 and BRCA2, respectively, relative to salpingectomy alone. Bilateral salpingo-oophorectomy yielded the lowest number of future breast and ovarian cancers compared with the other two strategies.

CONCLUSION:

Bilateral salpingo-oophorectomy offers the greatest risk reduction for breast and ovarian cancer among BRCA mutation carriers. However, when considering quality-adjusted life expectancy, bilateral salpingectomy with delayed oophorectomy is a cost-effective strategy and may be an acceptable alternative for those unwilling to undergo bilateral salpingo-oophorectomy.

• Authors: Janice S Kwon, Anna Tinker, Gary Pansegrau, Jessica McAlpine, Melissa Housty, Mary McCullum, C Blake Gilks
• Journal: Obstetrics and gynecology (Obstet Gynecol) Vol. 121 Issue 1 Pg. 14-24 (Jan 2013) ISSN: 1873-233X [Electronic] United States
• PMID: 23232752 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Breast Neoplasms (economics, genetics, prevention & control)
• Computer Simulation
• Female
• Genes, BRCA1
• Genes, BRCA2
• Humans
• Mammaplasty (economics)
• Markov Chains
• Mastectomy (methods)
• Middle Aged
• Models, Biological
• Mutation
• Ovarian Neoplasms (economics, genetics, prevention & control)
• Ovariectomy (methods)
• Quality of Life
• Quality-Adjusted Life Years
• Risk Reduction Behavior
• Salpingectomy (methods)
• Treatment Outcome