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Rationale for study

RRSO (risk reducing salpingo-oophorectomy) has been reported to reduce the risk of epithelial ovarian cancer (EOC) by >80%. While initial data suggested that premenopausal RRSO reduces primary and contralateral breast cancer risk, recent research has questioned this. However, RRSO leads to a reduction in cancer specific and all-cause mortality. Nevertheless RRSO is not without detrimental consequences. In pre-menopausal women it leads to surgical menopause and the cessation of fertility. Women must be adequately counselled regarding the effects of premature surgical menopause and its detrimental health sequelae including increased risk of cardiovascular disease, osteoporosis, vasomotor symptoms, dementia/cognitive dysfunction and sexual dysfunction, particularly in women who do not or are unable to take hormone replacement therapy (HRT). As a result, a number of women choose to delay surgery until after menopause.

With growing evidence that the fallopian tube is the site of origin of a large proportion of EOC, RRESDO (risk reducing early salpingectomy with delayed oophorectomy) has been suggested as an attractive two-stage alternative prevention strategy to RRSO. This has the advantage of providing some level of risk reduction to women who wish to decline or delay RRSO whilst conserving ovarian function and avoiding the detrimental sequelae of early surgical menopause. However, prospective outcome data for this approach are lacking. The exact extent of ovarian cancer risk reduction plus long-term consequences on ovarian function are not known. Concerns have also been voiced regarding the potential attrition from delayed oophorectomy. A proportion of women who do not undergo this may develop ovarian cancer. Therefore, RRESDO should only be currently offered in the safe environment of a clinical trial and we found 80% of UK clinicians are supportive of this.

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