Australian Clinicians Uncertain About Managing Risk-Reducing Bilateral Salpingo-Oophorectomy

By Marilynn Larkin

October 13, 2019

NEW YORK (Reuters Health) - A survey of Australian healthcare professionals managing premenopausal women at high genetic risk for ovarian cancer revealed uncertainty surrounding risk-reducing bilateral salpingo-oophorectomy (RRBSO).

While RRBSO can reduce the risk of ovarian cancer for women at high risk, it "usually leads to abrupt surgical menopause," Dr. Martha Hickey of the University of Melbourne in Victoria told Reuters Health by email. "This study was asking healthcare professionals caring for these women whether they were confident managing surgical menopause.

Dr. Hickey and colleagues surveyed 47 (out of 118 invited) healthcare professionals across 10 disciplines and specialties. Participants were asked to rate their perceived level of knowledge about the consequences of premenopausal RRBSO for ovarian cancer risk, the surgical procedure and recovery, and the noncancer consequences.

They were also asked to rate what they perceived to be the most common concerns around RRBSO for high-risk women; what they believed influenced women not to have an RRBSO at the recommended, evidence-based age; and whether they provided women with any written material or other resources about RRBSO or referred them to other specialists or services.

As reported online September 16 in Menopause, most respondents were genetic counselors (47%), nurses (19%) or medical oncologists (11%).

Most participants (77%) said that providing advice about RRBSO was part of their professional responsibility. Almost all (81%) provided information about RRBSO, but there was considerable uncertainty about who was responsible for making decisions with the women about the procedure.

Specifically, almost all (91%) thought the gynecological oncologist was responsible for decision-making with patients; however, 62% also thought that a gynecologist, geneticist (74%) or genetic counselor (77%), breast or general surgeon (53%), GP (25%), nurse (28%), or "other" healthcare professionals (8.5%), including a gastroenterologist, "anyone who is trained," or medical oncologist, should be involved in decision-making.

Most respondents (85%) were "quite a bit" or "extremely" confident about informing high-risk women about ovarian cancer risk reduction from RRBSO and the surgical procedure (47%), but only one-third were "quite a bit" or "extremely" confident about discussing (36%) or managing (31%) surgical menopause.

Surgical menopause was considered the main barrier to RRBSO (88%, "quite a bit" or "extremely"), and most respondents (78%) wanted more information and resources about surgical menopause for high-risk women.

Dr. Hickey said her team has produced new resources for healthcare professionals ( and patients ( to address the knowledge gaps.

Underlying the uncertainty and lack of confidence is a lack of prospective studies, she noted. Her team is currently conducting a large prospective 24-month study of surgical menopause, called WHAM - What Happens after Menopause? (

"When the WHAM data are published, we will update the resources to ensure that women and their healthcare professionals have access to the highest quality information about the non-cancer consequences of RRBSO," she said.

But Dr. Kecia Gaither, Director of Perinatal Services at NYC Health and Hospitals/Lincoln in Bronx, New York, said in an email to Reuters Health, "I don't find, with physicians within my arena, any reluctance or lack of clarity in how to treat these patients."

"There is a quite clear pathway for care to be rendered upon demonstration of a history which denotes increased risk," she said. "In my...experience, once a woman has seen her gynecologist, and a history is elicited which reflects a family history of ovarian and/or breast cancer, the patient is referred to a geneticist for testing. Should the findings reveal they are carriers, the patient is then referred to a gynecologic oncologist for evaluation/disposition."


Menopause 2019.