RISK-REDUCING surgery decisions were shaped most by ovarian cancer risk and menopausal symptoms in premenopausal women.
Risk-Reducing Surgery Decisions Reflect Patient Priorities
Risk-reducing surgery decisions were shaped most by ovarian cancer risk and menopausal symptoms in premenopausal women. In this survey study, investigators examined how women at familial or hereditary risk of ovarian cancer weighed competing outcomes when considering risk-reducing salpingo-oophorectomy, risk-reducing salpingectomy, or surveillance. The findings showed that participants overall preferred risk-reducing salpingo-oophorectomy, but that preference was tempered by concerns about long-term health risks and the burden of menopause.
Risk-Reducing Surgery and Ovarian Cancer Risk
The study enrolled 355 premenopausal women seeking genetic testing at two tertiary cancer centers and used a discrete choice experiment to assess which features most strongly influenced prevention decisions. Participants were asked to compare hypothetical scenarios that varied by treatment type, lifetime ovarian cancer risk, expected age at diagnosis, risk of osteoporosis, risk of heart disease, timing of menopause, and severity of menopausal symptoms. Women preferred risk-reducing salpingo-oophorectomy over risk-reducing salpingectomy or observation, with an odds ratio of 1.24. However, increasing risks of osteoporosis and heart disease reduced the attractiveness of a given option, as did worsening menopausal symptoms. Preferences also favored a natural age of menopause and milder symptoms.
Menopausal Symptoms Shaped Decision-Making
Importantly, the analysis suggested that the type of procedure itself was less influential than the total risk profile attached to each scenario. The study authors found that ovarian cancer risk and menopausal symptom burden were among the most salient concerns, while heart disease, osteoporosis, and timing of menopause also contributed to decision-making. Family history further modified preferences. Women with a family history of ovarian cancer were more likely to prefer risk-reducing salpingo-oophorectomy, while women with children were also more likely to choose more aggressive treatment. By contrast, a positive ovarian cancer related genetic test result did not significantly alter preferences.
These findings suggest that counseling should extend beyond discussion of cancer prevention alone. The authors argued that personalized guidance addressing cardiovascular risk, bone health, and menopausal effects may better support women facing these complex decisions. They also noted that conjoint analysis could offer a useful framework for tailoring discussions to individual priorities, although the study’s theoretical scenarios and relatively homogenous academic-center population may limit generalizability. Overall, the results reinforce the value of more nuanced counseling models for women considering risk-reducing surgery.
Reference
Daly MB et al. Personalized Decision-Making in Risk-Reducing Surgery of the Ovaries. JAMA Network Open. 2026;9(3):e263404. doi:10.1001/jamanetworkopen.2026.3404.
Featured Image: Syda Productions on Adobe Stock.
