Women at High Risk of Ovarian Cancer: Navigating Surgical Options and their Risks
Genetic testing has helped to identify the number of women at risk of ovarian cancer. To reduce the risk of developing the disease, women who are carriers of identified gene mutations linked to ovarian cancer and at high inherited risk are often recommended to have surgery—known as ‘risk reducing bilateral salpingo-oophorectomy’— or, removing both ovaries and fallopian tubes.
Previous research has identified the impact this surgery has on reducing ovarian cancer risk, however less is known about the non-cancer consequences. This includes issues such as the symptoms women can have post-surgery, how women can best be treated and how health professionals can best optimise a woman’s long-term health in this situation.
Recently published research led by Prof. Martha Hickey conducted at Peter MacCallum Cancer Centre in Melbourne interviewed women considering surgery to decrease their risk of ovarian cancer to understand the barriers and facilitators of undergoing such procedures. Complimenting this, health care professionals were interviewed about their unmet needs for information to best support patients.
What was found?
The research identified a lack of clarity about who is responsible for the management of surgical menopause in high risk women, what the management plan should be, who discusses hormone therapy for those women and how it is prescribed, and how to offer these women follow up care.
Women at high-risk of ovarian cancer
The research indicated that among high-risk women, reducing their personal risk of ovarian cancer was the main motivation for why this surgery was undertaken. The main reason that prevented women from having this surgery was loss of fertility; including for women over 45, when the age of natural conception was likely to have passed. Other factors identified included:
- Symptoms associated with surgical menopause – the average age of undergoing this surgery in Australia is before 45 while the average age of menopause is 51.
- Lack of clarity surrounding long-term health impacts of the condition. Additional concerns of the surgery included the timing of the surgery (in terms of age).
- Impacts the surgery could have on bone health and sexual function.
A gap in resources for health care professionals who are counselling these patients was also identified. The research showed that health professionals felt confident about the ability to provide information about the benefits of cancer risk reduction for this surgery, however felt less confident about providing information about the symptoms of surgical menopause.
Health care professionals also felt less confident about whose role and responsibility it was—doctors, nurses or other allied health professionals—to explain to patients when they should have the operation and how to manage the potential side-effects. Additionally, there was a lack of evidence regarding the optimum dose of hormone therapy to manage menopausal symptoms, and prevent long-term non-communicable diseases such as osteoporosis and heart disease.
Addressing the unmet needs
The research team has addressed these gaps by:
- providing a multi-disciplinary clinic where high risk women are reviewed prior to surgery and discuss the eligibility for hormone replacement therapy after surgery, in conjunction with modification of other lifestyle and risk factors
- reviewing women again after surgery and actively managing any ongoing post-menopausal symptoms
- developing education and information resources for high risk women and health care professionals
The authors of this study welcome input from other researchers in how other health settings have best designed their clinical services to manage women in similar situations. The authors look forward to improving clinical outcomes in high risk women with the results of a large study The Women’s Health After Surgical Menopause (WHAM), to be released in early 2021.
Author: Rebecca Madill
Click the video below to find out more about the project from Prof Hickey
Prof Martha Hickey is a Professor of Obstetrics and Gynaecology and Head of the Gynaecology Research Centre at the University of Melbourne and the Royal Women’s Hospital, Victoria, Australia, and an NHMRC Practitioner Fellow. She is a member of the MACH Women’s and Newborn Health and Care of the Ageing subcommittees.
In her clinical practice Prof Hickey runs the largest public menopause service in Australia and in 2002 established the first multidisciplinary service for managing menopausal symptoms after cancer (MSAC). This service has now been replicated across Australia. She is a Senior Editor for the Cochrane Collaboration Gynaecology and Infertility Group and leads the international COMMA (Core Outcomes in Menopause) initiative as part of the COMET (Core Outcomes in Effectiveness) program.
Prof Hickey is also leading Flesh After Fifty “changing images of older women in art”- an exhibition about older women and their bodies that includes an extensive public and educational program.
Held between 29 March – 3 May 2020 at the Abbotsford Convent, Melbourne.