Patient Preferences for Ovarian Cancer Risk–Reducing Treatments Revealed Through Choice Experiments

Women at elevated risk of ovarian cancer, particularly those with BRCA1/2 and other high-risk pathogenic variants, must weigh the merits of cancer surveillance or risk-reducing strategies against the resulting adverse effects.The most effective strategy, bilateral salpingo-oophorectomy, induces premature or early menopause in many women. 1Consequently, many at-risk women delay or decide against surgery. 2 More recently, interval salpingectomy with delayed oophorectomy has been proposed as a valid alternative to reduce risk and retain ovarian function given that the fallopian tube is the site of origin for most serous ovarian carcinomas. [3][4]4][5] The right choice for a patient depends on her preference-sensitive decisions and priorities.Daly et al 6 explore the drivers of decision-making for risk-reducing surgery among women with elevated ovarian cancer risk.Eligible participants from 2 hereditary cancer clinics had a personal history of breast cancer and/or a familial risk of hereditary breast or ovarian cancer and sought genetic testing.Women completed a survey of demographic data and were provided basic education on treatment options to reduce ovarian cancer risks and their associated adverse effects.Participants chose between paired hypothetical scenarios that reflect different states of health and the value patients attach to these attributes, including mitigating cancer risk.A conjoint analysis design evaluated patient trade-offs weighing combinations of attributes to reflect the how patients approached these complex health care decisions.A total of 355 participants with a median age of 37 years completed the survey twice, prior to and then 2 months following, the disclosure of the genetic test results.Interactions between patient demographics, personal and family cancer history, and genetic test results were analyzed.Women preferred risk-reducing salpingo-oophorectomy to risk-reducing salpingectomy (odds ratio, 1.24; 95% CI, 1.10-1.39). 6Choices were not influenced by the timing of disclosure of genetic test results, or the presence or absence of a cancer-related pathogenic variant.Forty-seven study participants (13%) had pathogenic variants in ovarian cancer-related genes.Risk-reducing salpingectomy was the least preferred treatment, although the difference between surveillance and risk-reducing salpingectomy was not statistically significant.The dominant driver of preferences was how much that choice reduced the risk of ovarian cancer, although this was slightly attenuated by older age.Scenarios with menopause-associated conditions risks, such as osteoporosis, heart disease, and more severe menopause symptoms, reduced these preferences, but these were less impactful than the optimal cancer risk reduction achieved with salpingo-oophorectomy.The study design sheds important light on the process by which women with elevated cancer risks make decisions regarding cancer prevention.Presenting women with hypothetical options allowed the authors to understand how health preferences reflect the inherent trade-offs of risk reduction and adverse effects.Although the study population, which was predominantly White and college graduates, may limit how the findings apply to more diverse populations, there are important concepts that should guide patient counseling to improve informed patient choice.The study findings will be foundational in designing counseling protocols that reflect the combination, and priorities, expressed by women with elevated ovarian cancer risk.Effective shared decision-making models for women with elevated risk of ovarian cancer will be informed by the risk thresholds, values, and preferences revealed in the study by Daly et al. 6 The study also noted modifying effects that influenced preferences for surgical prevention interventions, such as a family history of ovarian cancer, patient age, and having children.Incorporating these factors allows for individualized +