Summary of findings for the main comparison. Risk‐reducing salpingo‐oophorectomy (RRSO) versus no RRSO in BRCA1 or BRCA2 mutation carriers.
| RRSO vs no RRSO in BRCA1 or BRCA2 mutation carriers | ||||||
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Participants: women with BRCA1 or BRCA2 mutation carriers Settings: hospitals in Europe and USA Intervention: RRSO with or without risk‐reducing mastectomy Comparison: no RRSO or surveillance | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | RRSO vs no RRSO in BRCA1 or BRCA2 mutation carriers | |||||
| Overall survival: BRCA1 or BRCA2 Follow‐up: median 0.5–27.4 years | Study population | HR 0.32 (0.19 to 0.54) | 2548 (3 studies) | ⊕⊝⊝⊝ Very lowa | As a result of the way HRs were calculated, assumed and corresponding risks were not estimated. | |
| See comment | See comment | |||||
| Moderate | ||||||
| — | — | |||||
| HGSC mortality: BRCA1 or BRCA2 Follow‐up: median 0.5–27 years | Study population | HR 0.06 (0.02 to 0.17) | 2534 (3 studies) | ⊕⊝⊝⊝ Very lowa | As a result of the way HRs were calculated, assumed and corresponding risks were not estimated. | |
| See comment | See comment | |||||
| Moderate | ||||||
| — | — | |||||
| Breast cancer mortality: BRCA1 or BRCA Follow‐up: median 0.5–27 years | Study population | HR 0.58 (0.39 to 0.88) | 7198 (7 studies) | ⊕⊝⊝⊝ Very lowa | As a result of the way HRs were calculated, assumed and corresponding risks were not estimated. | |
| See comment | See comment | |||||
| Moderate | ||||||
| — | — | |||||
| Bone fracture incidence Follow‐up: median 0.5–27 years | See comment | See comment | Not estimable | 0 (0) | See comment | No studies reported this outcome. |
| Quality of life (ovarian cancer risk perception): BRCA1 or BRCA2 Follow‐up: mean 1 years | See comment | See comment | Not estimable | 200 (1 study) | ⊕⊝⊝⊝ Very lowa | Unable to perform meta‐analysis as only 1 study reported the outcome. |
| Quality of life (breast cancer risk perception): BRCA1 or BRCA2 Follow‐up: mean 1 years | See comment | See comment | Not estimable | 200 (1 study) | ⊕⊝⊝⊝ Very lowa | Unable to perform meta‐analysis as only 1 study reported the outcome. |
| Severe adverse events Follow‐up: mean 1 years | See comment | See comment | Not estimable | 0 (0) | See comment | No studies reported this outcome. |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). BRCA1: breast cancer 1 gene; BRCA2: breast cancer 2 gene; CI: confidence interval; HGSC: high‐grade serous cancer; HR: hazard ratio; RRSO: risk‐reducing salpingo‐oophorectomy. | ||||||
| GRADE Working Group grades of evidence High‐certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate‐certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. low‐certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low‐certainty: we are very uncertain about the estimate. | ||||||
aDowngraded by one level for serious risk of bias: there was overall moderate risk of bias (bias due to selection of participants into the study and bias due to missing data) in all the studies.