Gynecologic oncology · 2026
"I was in the driver's seat": A qualitative analysis of factors promoting and delaying previvors' oophorectomy after risk-reducing salpingectomy.
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Chess Isabel, Holtzman Sharonne, Cox Madison, Leschly Jayme, Gellman Caroline, Blank Stephanie V
Аннотация
OBJECTIVE: Previvors are increasingly choosing risk-reducing salpingectomy (RRS) with delayed oophorectomy (DO) as their risk-reducing strategy. We explored clinical and non-clinical factors influencing decisions regarding timing of DO after RRS.
METHODS: Our cohort included BRCA previvors who underwent RRS at an urban gynecologic oncology clinic. We conducted semi-structured Zoom interviews with previvors and transcribed verbatim. Two investigators performed thematic analysis independently to code four transcripts, reconciling discrepancies with a blinded moderator, and developing a codebook which was iteratively refined and applied across transcripts. We identified 23 codes, 10 subthemes, and three major themes.
RESULTS: Sixteen previvors participated (median age 43), evenly split between BRCA 1 and 2 mutations. Five had undergone DO. Three major themes emerged from thematic analysis: factors promoting oophorectomy, factors delaying oophorectomy, and physician relationships. Those undergoing DO were motivated by cancer-related anxiety and practical considerations (e.g., other cancer diagnoses, motherhood). While both groups expressed menopause concerns, those undergoing DO more often emphasized cancer anxiety as the primary decision driver. Additionally, desiring to remain healthy for motherhood and family cancer experiences facilitated earlier timing of DO. Conversely, patients who had not undergone DO emphasized emotional and practical concerns regarding menopause and external life responsibilities as delaying influences. Regardless of decision, participants highlighted self-advocacy and strong physician relationships as essential to shared decision making.
CONCLUSION: Timing of DO following RRS reflects a balance between cancer anxiety and surgical menopause concerns. Recognizing these factors may help physicians support patient needs and strengthen partnerships that promote both shared decision-making and cancer risk reduction.
METHODS: Our cohort included BRCA previvors who underwent RRS at an urban gynecologic oncology clinic. We conducted semi-structured Zoom interviews with previvors and transcribed verbatim. Two investigators performed thematic analysis independently to code four transcripts, reconciling discrepancies with a blinded moderator, and developing a codebook which was iteratively refined and applied across transcripts. We identified 23 codes, 10 subthemes, and three major themes.
RESULTS: Sixteen previvors participated (median age 43), evenly split between BRCA 1 and 2 mutations. Five had undergone DO. Three major themes emerged from thematic analysis: factors promoting oophorectomy, factors delaying oophorectomy, and physician relationships. Those undergoing DO were motivated by cancer-related anxiety and practical considerations (e.g., other cancer diagnoses, motherhood). While both groups expressed menopause concerns, those undergoing DO more often emphasized cancer anxiety as the primary decision driver. Additionally, desiring to remain healthy for motherhood and family cancer experiences facilitated earlier timing of DO. Conversely, patients who had not undergone DO emphasized emotional and practical concerns regarding menopause and external life responsibilities as delaying influences. Regardless of decision, participants highlighted self-advocacy and strong physician relationships as essential to shared decision making.
CONCLUSION: Timing of DO following RRS reflects a balance between cancer anxiety and surgical menopause concerns. Recognizing these factors may help physicians support patient needs and strengthen partnerships that promote both shared decision-making and cancer risk reduction.