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Threshold for surgery to reduce ovarian cancer risk should be lowered, suggests study

BMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i3559 (Published 28 June 2016) Cite this as: BMJ 2016;353:i3559
  1. Susan Mayor
  1. London

The threshold for surgery in which the ovaries and fallopian tubes are removed to reduce the risk of ovarian cancer in premenopausal women older than 40 should be lowered from the current lifetime risk of over 10% to 4% or lower, a cost effectiveness study has shown.1

Salpingo-oophorectomy is the most effective method for reducing the risk of ovarian cancer in premenopausal women at high risk of developing the disease. But it is currently recommended only for women with at least a 10% lifetime risk of developing the disease, such as those carrying the BRCA1/2 gene.

This threshold has not been formally tested for its cost effectiveness, so a group of UK researchers modelled the lifetime costs and effectiveness of salpingo-oophorectomy in premenopausal women, aged at least 40 with different levels of lifetime risk for ovarian cancer, compared with the costs of not carrying out surgery.

The research group estimated costs and effects in terms of quality adjusted life years (QALYs), incidence of ovarian and breast cancer, and the incremental cost effectiveness ratio.

Results showed that carrying out surgery would be highly cost effective in premenopausal women over 40 with a lifetime ovarian cancer risk of 4% or greater at the threshold of £20 000-£30 000 (€26 100-€39 100; $29 500-$44 500) for each QALY. This would equate to an increase of more than 42.7 days in life expectancy for an overall incremental cost effectiveness ratio of £19 536 per QALY.

The research group, led by Ranjit Manchanda, from Barts Cancer Institute, Queen Mary University of London, said, “Our results are of major significance for clinical practice and risk management in view of declining genetic testing costs and the improvements in estimating an individual’s ovarian cancer risk.”

They concluded, “With routine clinical testing for certain moderate penetrance genes around the corner and lack of an effective ovarian cancer screening programme, these findings are timely as they provide evidence supporting a surgical prevention strategy for ‘lower risk’ individuals.”

References

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