Table 2.

Studies Reporting Significant Predictors of the use of RRSO

Study	Study Population	Percent who had RRSO	Follow-up	Predictors/ Impact
▪Antill et al. (2006) ▪Retrospective ▪Clinic based ▪Multisite	▪Moderate or high risk women for ovarian cancer or BRCA1/2 carriers (unaffected) ▪N = 52 ▪Median age = 45 (22–74)	▪17.3% ▪Varies across centers (12–41%)	▪Mean follow-up time: 3.73 years. ▪Mean time from consultation to surgery: 3.36 months	▪ Predictors: Univariate – > 40 yrs (+)a – BRCA1/2 (+) ▪ Impact: – Lower perceived risk
▪Beattie et al. (2009) ▪Prospective ▪Clinic based ▪Multisite	▪BRCA1/2 carriers (affected and unaffected) ▪N = 240 ▪Median age = 45 (20–79)	▪51% (no significant differences across sites)	▪Median follow-up time: 3.7 years. ▪Median interval from receipt of test result to surgery: 4 months	▪ Predictors: Univariate – Age (+) for women less than 60 – BCb (+) – RRMc (+)
▪Botkin et al. (2003) ▪Prospective ▪Clinic based ▪Single site	▪K2082 kindred - BRCA1/2 carriers (affected and unaffected) ▪N = 26 ▪Mean age = 43.45 (27–72)	▪46% among all carriers	▪Follow-up time: 24 months	▪ Predictors: Univariate – Appears to be an effect for age ( >40: 78%; <40: 29%) (+), but significance level not reported.
▪Bradbury et al. (2008) ▪Retrospective ▪Clinic based ▪Single site	▪BRCA1/2 carriers (affected and unaffected) ▪N = 88 ▪Median age = 42 (23–71)	▪70% ▪26% of those had surgery before receipt of genetic test result	▪Median interval from receipt of test result to surgery: 12.5 months	▪ Predictors: Univariate – Age (+) – CHd (+) – BC (+) – Being white (+) – RRM (+) – FHe (+) Multivariate – Age – CH – Being white – FH
▪Evans et al. (2009) ▪Prospective ▪Clinic based ▪Single site	▪BRCA1/2 carriers (unaffected). ▪N = 211 ▪Age >18	▪BRCA1 mutation carrier: 52% ▪BRCA2 mutation carrier: 28%	▪Median follow-up time: 4.19 years.	▪ Predictors: Univariate – BRCA1 (+)
▪Fry et al. (2001) ▪Retrospective ▪Clinic based ▪Single site	▪Affected and unaffected women at moderate or high risk based on family history ▪Women were operated on 1 to 5 years earlier ▪Comparison group also at moderate to high risk registered 1 to 5 years earlier ▪Surgical group N = 30 ▪Control group: N = 28 ▪Mean age = 50.1 (35–66)	NA	NA	▪ Predictors: Differences between surgical and non-surgical groups in importance rating for each decision-making factor: Univariate – Age (+) – Reducing risk (+) – Reducing worry (+) – Recovery time (−)a – Worry about effectiveness of screening (+) – Loss of periods (+) Multivariate – Reducing worry
▪Kauf et al. (2002) ▪Prospective ▪Clinic based ▪Single site	▪BRCA1/2 carriers (affected and unaffected) ▪Excluded women younger than 35 and women who had RRSO prior to genetic testing ▪N = 170 ▪Mean age = 46.65 (35–78)	▪58%	▪Mean follow-up time: 24.2 months ▪Median interval from receipt of test result to surgery: 3.6 months	▪ Predictors: Univariate – More likely to have had BMf before the start of the follow-up
▪Kram et al. (2006) ▪Retrospective ▪Clinic based ▪Single site	▪Affected and unaffected women who underwent testing for founder mutations based on the ethnic origin of the patient ▪Included women who had BSOg prior to genetic testing for various reasons ▪BRCA1/2 carriers: N = 43 ▪Non-carriers: N = 56 ▪Mean age = 53.75	▪78% of carriers ▪11% of those had surgery prior to receipt of genetic test result ▪18% of non-carriers (40% of those prior to receipt of genetic test result)	▪Follow-up time: 1–4 years after receipt of genetic test result	▪ Reasons for having surgery: – Reduction of risk – Reduction of anxiety – Lack of trust in surveillance methods ▪ Predictors: Univariate – BRCA1/2 (higher percentages are found in age group > 50 (89%) when compared to < 50 (44%) – More women with BC found among non-carriers who had RRSO, but significance levels not reported
▪Madalinska et al. (2005) ▪Cross-sectional ▪Clinic based ▪Multisite	▪High risk women (affected and unaffected) who had RRSO (N = 369) ▪High risk women (affected and unaffected) who had surveillance (N = 477) ▪Mean age = 47.87 (30–75)	NA	NA	▪ Predictors: Univariate – Age (+) – BC (+) – BRCA1/2 (+) – RRM (+) ▪ Impact: Univariate – 97% satisfied with decision – Less anxiety – Lower perceived risk – Negative impact on sexual functioning
▪Madalinska et al. (2007) ▪Prospective ▪Clinic based ▪Multisite	▪BRCA1/2 carriers (affected and unaffected) ▪Greater than 35 ▪Cmpleted childbearing ▪N= 160 ▪Mean age = 47.51	▪74% within 12 months of initial genetic testing consultation	▪Median interval from consultation to surgery: 2.8 months	▪ Predictors: Univariate – Age (+) – Married (+) – Education (−) – Menopausal status (+) – Distress (+) – Perceived health (−) – Perceived risk (+) – Ovarian cancer is incurable (+) – Surgery will increase certainty (+) – Benefits of surgery (+) Multivariate – Education – Perceived health – Ovarian cancer is incurable – Benefits of surgery
▪Meijers-Heirboer et al. (2003) ▪Prospective ▪Clinic based ▪Single site	▪BRCA1/2 affected carriers ▪Age greater than 35 ▪N = 95 ▪59 women <50 ▪36 women >=50	▪49%	▪Mean time from genetic test result to surgery: 8 months.	▪ Predictors: Univariate – Women with BC at stage I more likely than those at stage II or III
▪Meijers-Heirboer et al. (2000) ▪Prospective ▪Clinic based ▪Multisite	▪BRCA1/2 unaffected carriers ▪N = 60 ▪Age range 30–80	▪64% of eligible women > 35. ▪35–40: 41% ▪40–54: 90% ▪>54: 50% ▪<35: 47%	▪Median follow-up time: 26 months.	▪ Predictors: Univariate – Higher percentages in age group 40–54 than in 35–40
▪Metcalfe et al. (2008) ▪International ▪Prospective Clinic based ▪Multisite	▪BRCA1/2 carriers (affected and unaffected) ▪Did not distinguish between surgeries performed for risk reduction and those performed for other reasons ▪N = 2677 ▪Mean age: 45.6 (25–80)	▪Range varied from 34.9% (Poland) to 73% (Norway)	▪Mean follow-up time from genetic test result: 3.9 years.	▪ Predictors: Univariate – BC (+)
▪Metcalfe et al. (2007) ▪Prospective ▪Clinic based ▪Multisite	▪BRCA1/2 carriers (affected and unaffected) ▪Did not distinguish between surgeries performed for risk reduction and those performed for other reasons ▪N = 672 ▪Mean age = 46.9 (25–79)	▪54% (range: 38.9–67.3%) ▪(41% of those prior to receipt of genetic test result) ▪25–35: 22% ▪36–40: 45% ▪41–60: 64% ▪61–70: 59% ▪>70: 47%	▪Mean follow-up time from genetic test result: 4 years	▪ Predictors: Univariate – BC (+)
▪Metcalfe et al. (2008) ▪Prospective ▪Clinic based ▪Multisite	▪BRCA1/2 carriers (affected and unaffected) ▪N = 517 ▪Mean age for total sample = 46.8 (25–79)	▪67% (age greater than 35)	▪Mean follow-up time from genetic test result: 4.5 years	▪ Predictors: Multivariate – Age (+) – FH (+) – BRCA1 (+)
▪Miller et al. (2005) ▪Prospective ▪Clinic based ▪Single site	▪High risk women tested for BRCA1/2 (affected and unaffected). N = 77	▪60%	▪Mean follow-up time from genetic test result: 6 months	▪ Predictors: Multivariate – Intervention (+) – BRCA1/2 (+) – Education (−)
▪Scheuer et al. (2002) ▪Prospective ▪Clinic based ▪Single site	▪BRCA1/2 carriers (affected and unaffected) ▪N=179 ▪Mean age = 47.7 (24.1–79.0)	▪50.3%	▪Median interval from genetic test result to surgery: 3.4 months	▪ Predictors: Univariate – Age (+) – BC (+)
▪Schmeler et al. (2006) Prospective ▪Clinic based ▪Single site	▪BRCA1/2 carriers (affected and unaffected) ▪N=106. ▪Mean age: 43.37 (19.6–71.1)	▪61.3% ▪<35: 10.77%, ▪36–40:16.92%, ▪41–45:26.15%, ▪>45: 46.15%	▪Median interval from genetic test result to surgery: 4.6 months	▪ Predictors: Univariate – Age (+) – CH (+) – BC (+)
▪Schwartz et al. (2003) ▪Prospective ▪Clinic based ▪Single site	▪High risk women tested for BRCA1/2 (affected and unaffected) ▪N = 289 ▪Mean age: 47 (>25)	▪Carriers: 27% ▪Uninformatives: 5% ▪Non-carriers: 2%	▪Follow-up time from genetic test result: 12 months	Predictors: Univariate – BRCA1 (+) – Perceived risk (+) – Worry (+) – FH (+) Multivariate – BRCA1 – Perceived risk at baseline – FH
▪Skytte et al. (2010) ▪Retrospective ▪Population based	▪BRCA1/2 carriers (unaffected) ▪N=306 ▪265 women < 50 ▪41 women >= 50	▪75%	▪Follow-up time from genetic test result: 10 years ▪Median interval from genetic test result to surgery: 34 months (13 months for women over 35)	▪ Predictors: Univariate – Age (+) – CH (+)
▪Tiller et al. (2002) ▪Prospective ▪Clinic based ▪Multisite	▪Unaffected high risk: 91% ▪Unaffected moderate risk: 9% ▪N=68 ▪Median age: 40 (19–75)	▪23.2% of total ▪40% of women recommended for RRSO	▪Mean follow-up time from genetic test result: 3 years	▪ Predictors: Univariate – Age (+) – FH (+) (trend) ▪ Impact: – 86.4% satisfied with decision – Greater reduction in cancer anxiety when compared to surveillance group – Women not on HRT reported negative impact on sexual functioning
▪Uyei et al (2006) ▪Retrospective ▪Clinic based ▪Singel Site	▪Women tested for BRCA1/2 (affected and unaffected) ▪Risk level of participants unclear ▪Unclear whether surgeries were performed for risk reduction or for other reasons ▪N= 554 ▪36 women < 50 ▪29 women >=50	▪14.8% had RRSO.		▪ Predictors: Univariate – BRCA1/2 (+) – BC (+) – Lower stage disease (+) – FH (+) – HRT (+) – OCPh (+) – Total mastectomy as part of treatment for breast cancer (+) Multivariate – BRCA1/2

^a‘+’: positive effect and ‘−’, negative effect

^bBC: personal history of breast cancer

^cRRM: risk reducing mastectomy

^dCH: has at least one child

^eFH: family history of ovarian cancer

^fBM: bilateral mastectomy

^gBSO: bilateral salpingo-oophorectomy

^hOCP: use of oral contraceptive pills