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Systematic Review of Acceptability, Cardiovascular, Neurological, Bone Health, and HRT Outcomes following Risk Reducing Surgery in BRCA carriers

Gaba, F; Manchanda, R; (2020) Systematic Review of Acceptability, Cardiovascular, Neurological, Bone Health, and HRT Outcomes following Risk Reducing Surgery in BRCA carriers. Best Practice & Research Clinical Obstetrics & Gynaecology , 65 pp. 46-65. 10.1016/j.bpobgyn.2020.01.006. Green open access

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Abstract

Primary surgical prevention in the form of risk-reducing salpingo-oophorectomy (RRSO) is the most effective option and gold standard for ovarian cancer (OC) risk-reduction, particularly given the absence of an effective national OC screening programme. However, premenopausal RRSO leads to premature surgical menopause with detrimental long-term health sequelae particularly in women who do not/are unable to take hormone replacement therapy (HRT). HRT uptake in women undergoing pre-menopausal oophorectomy appears low and is dependent on informed counselling, on the safety of HRT and efficacy in mitigating the health sequelae of premature menopause. Acceptance of a central role for the fallopian tube in OC etiopathogenesis coupled with detrimental consequences of premature menopause, has led to the attractive proposal of early-salpingectomy with delayed oophorectomy as an alternative OC surgical prevention strategy in premenopausal women who have completed their family but decline or wish to delay RRSO. The successful implementation of risk reducing surgery for OC prevention depends on acceptability of surgery to both recipients (e.g. BRCA1/BRCA2 carriers) and intervention deliverers (healthcare professionals/researchers). Acceptability is also informed by an understanding of health outcomes following risk reducing surgery and the safety of HRT. It is therefore vital to understand the effects of surgery on important health outcomes such as cardiovascular health, neurological function and bone health. We present a comprehensive review of acceptability, selected health outcomes above and HRT safety following risk reducing surgery.

Type: Article
Title: Systematic Review of Acceptability, Cardiovascular, Neurological, Bone Health, and HRT Outcomes following Risk Reducing Surgery in BRCA carriers
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.bpobgyn.2020.01.006
Publisher version: https://doi.org/10.1016/j.bpobgyn.2020.01.006
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Targeted surgical prevention, RRSO, RRESD, Oovarian cancer, BRCA, acceptability
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology
URI: https://discovery.ucl.ac.uk/id/eprint/10092352
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