{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:03:26Z","timestamp":1792098206365,"version":"4.4.0"},"reference-count":77,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2013,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE:<\/jats:title>\n                    <jats:p>\n                      Prophylactic bilateral salpingo-oophorectomy is advised for women with\n                      <jats:italic toggle=\"yes\">BRCA<\/jats:italic>\n                      mutations, but there are adverse consequences of premature menopause. The majority of\n                      <jats:italic toggle=\"yes\">BRCA<\/jats:italic>\n                      -associated ovarian cancers appear to arise in the fallopian tube; therefore, salpingectomy may be an alternative to bilateral salpingo-oophorectomy. We compared the costs and benefits of salpingectomy with bilateral salpingo-oophorectomy among\n                      <jats:italic toggle=\"yes\">BRCA<\/jats:italic>\n                      mutation carriers.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>\n                      We developed a Markov Monte Carlo simulation model to compare three strategies for risk reduction in women with\n                      <jats:italic toggle=\"yes\">BRCA<\/jats:italic>\n                      mutations: 1) bilateral salpingo-oophorectomy; 2) bilateral salpingectomy; and 3) bilateral salpingectomy with delayed oophorectomy. Net health benefits were measured in years-of-life expectancy and quality-adjusted life-year expectancy, and the primary outcome was the incremental cost-effectiveness ratio. The model estimated the number of future breast and ovarian cancers and cardiovascular deaths attributed to premature menopause with each strategy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Bilateral salpingo-oophorectomy was associated with the lowest cost and highest life expectancy compared with the other two strategies. When quality-of-life measures were included, salpingectomy followed by delayed oophorectomy yielded the highest quality-adjusted life expectancy with incremental cost-effectiveness ratios of $37,805 and $89,680 per quality-adjusted life-year for\n                      <jats:italic toggle=\"yes\">BRCA1<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">BRCA2<\/jats:italic>\n                      , respectively, relative to salpingectomy alone. Bilateral salpingo-oophorectomy yielded the lowest number of future breast and ovarian cancers compared with the other two strategies.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSION:<\/jats:title>\n                    <jats:p>\n                      Bilateral salpingo-oophorectomy offers the greatest risk reduction for breast and ovarian cancer among\n                      <jats:italic toggle=\"yes\">BRCA<\/jats:italic>\n                      mutation carriers. However, when considering quality-adjusted life expectancy, bilateral salpingectomy with delayed oophorectomy is a cost-effective strategy and may be an acceptable alternative for those unwilling to undergo bilateral salpingo-oophorectomy.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/aog.0b013e3182783c2f","type":"journal-article","created":{"date-parts":[[2015,10,13]],"date-time":"2015-10-13T14:40:27Z","timestamp":1444747227000},"page":"14-24","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":134,"title":["Prophylactic Salpingectomy and Delayed Oophorectomy as an Alternative for BRCA Mutation Carriers"],"prefix":"10.1097","volume":"121","author":[{"given":"Janice S.","family":"Kwon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Tinker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary","family":"Pansegrau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"McAlpine","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Housty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"McCullum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. 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The tubal fimbria is a preferred site for early adenocarcinoma in women with familial ovarian cancer syndrome.","volume":"30","author":"Medeiros","year":"2006","journal-title":"Am J Surg Pathol"},{"key":"R14-5-20260317","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1097\/00000478-200110000-00009","article-title":"Occult carcinoma in prophylactic oophorectomy specimens: prevalence and association with BRCA germline mutation status.","volume":"25","author":"Colgan","year":"2001","journal-title":"Am J Surg Pathol"},{"key":"R15-5-20260317","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1007\/s10549-010-0799-x","article-title":". Occult ovarian cancers identified at risk-reducing salpingo-oophorectomy in a prospective cohort of BRCA12 mutation carriers.","volume":"124","author":"Domchek","year":"2010","journal-title":"Breast Cancer Res Treat"},{"key":"R16-5-20260317","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1001\/jama.296.2.185","article-title":". Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 Mutation.","volume":"296","author":"Finch","year":"2006","journal-title":"JAMA"},{"key":"R17-5-20260317","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1111\/j.1471-0528.2011.02920.x","article-title":". Outcome of risk-reducing salpingo-oophorectomy in BRCA carriers and women of unknown mutation status.","volume":"118","author":"Manchanda","year":"2011","journal-title":"BJOG"},{"key":"R18-5-20260317","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1097\/IGC.0b013e31821bc7e3","article-title":". 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Microscopic and early-stage ovarian cancers in BRCA12 mutation carriers: building a model for early BRCA-associated tumorigenesis.","volume":"4","author":"Yates","year":"2011","journal-title":"Cancer Prev Res (Phila)"},{"key":"R20-5-20260317","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1097\/PAS.0b013e3181bc6059","article-title":"Multistep level sections to detect occult fallopian tube carcinoma in risk-reducing salpingo-oophorectomies from women with BRCA mutations: implications for defining an optimal specimen dissection protocol.","volume":"33","author":"Rabban","year":"2009","journal-title":"Am J Surg Pathol"},{"key":"R24-5-20260317","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1177\/0272989X05282640","article-title":"Willingness to pay for a quality-adjusted life year: implications for societal health care resource allocation.","volume":"25","author":"King","year":"2005","journal-title":"Med Decis Making"},{"key":"R25-5-20260317","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1001\/jama.1996.03540150055031","article-title":"Recommendations of the panel on cost-effectiveness in health and medicine.","volume":"276","author":"Weinstein","year":"1996","journal-title":"JAMA"},{"key":"R27-5-20260317","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1093\/annonc\/mdj095","article-title":". 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Contralateral breast cancer in BRCA1 and BRCA2 mutation carriers.","volume":"22","author":"Metcalfe","year":"2004","journal-title":"J Clin Oncol"},{"key":"R31-5-20260317","doi-asserted-by":"crossref","first-page":"2437","DOI":"10.1200\/JCO.2005.02.7888","article-title":". Ten-year multi-institutional results of breast-conserving surgery and radiotherapy in BRCA12-associated stage III breast cancer.","volume":"24","author":"Pierce","year":"2006","journal-title":"J Clin Oncol"},{"key":"R32-5-20260317","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1086\/375033","article-title":". Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case series unselected for family history: a combined analysis of 22 studies.","volume":"72","author":"Antoniou","year":"2003","journal-title":"Am J Hum Genet"},{"key":"R33-5-20260317","doi-asserted-by":"crossref","first-page":"4282","DOI":"10.1200\/JCO.2008.16.6231","article-title":". Clinical and pathologic characteristics of patients with BRCA-positive and BRCA-negative breast cancer.","volume":"26","author":"Atchley","year":"2008","journal-title":"J Clin Oncol"},{"key":"R34-5-20260317","doi-asserted-by":"crossref","first-page":"1381","DOI":"10.1038\/ejhg.2009.60","article-title":"Risk-reducing surgery for ovarian cancer: outcomes in 300 surgeries suggest a low peritoneal primary risk.","volume":"17","author":"Evans","year":"2009","journal-title":"Eur J Hum Genet"},{"key":"R35-5-20260317","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1200\/JCO.2007.13.9626","article-title":". Risk-reducing salpingo-oophorectomy for the prevention of BRCA1- and BRCA2-associated breast and gynecologic cancer: a multicenter, prospective study.","volume":"26","author":"Kauff","year":"2008","journal-title":"J Clin Oncol"},{"key":"R36-5-20260317","doi-asserted-by":"crossref","first-page":"5261","DOI":"10.1002\/cncr.25439","article-title":". The molecular pathogenesis of hereditary ovarian carcinoma: alterations in the tubal epithelium of women with BRCA1 and BRCA2 mutations.","volume":"116","author":"Norquist","year":"2010","journal-title":"Cancer"},{"key":"R37-5-20260317","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1097\/AOG.0b013e3181a11c64","article-title":". Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses health study.","volume":"113","author":"Parker","year":"2009","journal-title":"Obstet Gynecol"},{"key":"R38-5-20260317","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1093\/jnci\/91.17.1475","article-title":". Breast cancer risk after bilateral prophylactic oophorectomy in BRCA1 mutation carriers.","volume":"91","author":"Rebbeck","year":"1999","journal-title":"J Natl Cancer Inst"},{"key":"R39-5-20260317","doi-asserted-by":"crossref","first-page":"397","DOI":"10.7326\/0003-4819-144-6-200603210-00006","article-title":". Cost-effectiveness of preventive strategies for women with a BRCA1 or a BRCA2 mutation.","volume":"144","author":"Anderson","year":"2006","journal-title":"Ann Intern Med"},{"key":"R40-5-20260317","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1056\/NEJMoa020119","article-title":". Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation.","volume":"346","author":"Kauff","year":"2002","journal-title":"N Engl J Med"},{"key":"R41-5-20260317","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.ygyno.2005.01.024","article-title":"Outcome of surveillance and prophylactic salpingo-oophorectomy in asymptomatic women at high risk for ovarian cancer.","volume":"97","author":"Meeuwissen","year":"2005","journal-title":"Gynecol Oncol"},{"key":"R42-5-20260317","doi-asserted-by":"crossref","first-page":"2474","DOI":"10.1016\/j.fertnstert.2011.03.032","article-title":". 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Variation in rates of uptake of preventive options by Canadian women carrying the BRCA1 or BRCA2 genetic mutation.","volume":"1","author":"Metcalfe","year":"2007","journal-title":"Open Med"},{"key":"R47-5-20260317","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1002\/micr.10138","article-title":"Cost-utility analysis comparing free and pedicled TRAM flap for breast reconstruction.","volume":"23","author":"Thoma","year":"2003","journal-title":"Microsurgery"},{"key":"R48-5-20260317","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1016\/j.ejso.2005.05.007","article-title":". Surgical decisions made by 158 women with hereditary breast cancer aged 50 years.","volume":"31","author":"Evans","year":"2005","journal-title":"Eur J Surg Oncol"},{"key":"R49-5-20260317","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1200\/JCO.2007.12.6078","article-title":". 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Genetic testing for a BRCA1 mutation: prophylactic surgery and screening behavior in women 2 years post testing.","volume":"118A","author":"Botkin","year":"2003","journal-title":"Am J Med Genet"},{"key":"R68-5-20260317","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1006\/pmed.2000.0684","article-title":". Prophylactic surgery decisions and surveillance practices one year following BRCA12 testing.","volume":"31","author":"Lerman","year":"2000","journal-title":"Prev Med"},{"key":"R69-5-20260317","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1002\/ajmg.a.10168","article-title":". Attitudes and distress levels in women at risk to carry a BRCA1BRCA2 gene mutation who decline genetic testing.","volume":"119A","author":"Lodder","year":"2003","journal-title":"Am J Med Genet"},{"key":"R70-5-20260317","doi-asserted-by":"crossref","first-page":"2015","DOI":"10.1016\/S0140-6736(00)02347-3","article-title":". Presymptomatic DNA testing and prophylactic surgery in families with a BRCA1 or BRCA2 mutation.","volume":"355","author":"Meijers-Heijboer","year":"2000","journal-title":"Lancet"},{"key":"R71-5-20260317","doi-asserted-by":"crossref","first-page":"4034","DOI":"10.1200\/JCO.2003.01.088","article-title":". Bilateral prophylactic oophorectomy and ovarian cancer screening following BRCA1BRCA2 mutation testing.","volume":"21","author":"Schwartz","year":"2003","journal-title":"J Clin Oncol"},{"key":"R72-5-20260317","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1200\/JCO.2004.04.188","article-title":". Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE Study Group.","volume":"22","author":"Rebbeck","year":"2004","journal-title":"J Clin Oncol"},{"key":"R73-5-20260317","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1093\/jnci\/93.21.1633","article-title":". Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers.","volume":"93","author":"Hartmann","year":"2001","journal-title":"J Natl Cancer Inst"},{"key":"R74-5-20260317","doi-asserted-by":"crossref","first-page":"4275","DOI":"10.1200\/JCO.2005.10.080","article-title":". Efficacy of prophylactic mastectomy in women with unilateral breast cancer: a cancer research network project.","volume":"23","author":"Herrinton","year":"2005","journal-title":"J Clin Oncol"},{"key":"R75-5-20260317","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1097\/SLA.0b013e3181c3c36d","article-title":". Prophylactic mastectomy in BRCA1 and BRCA2 mutation carriers: very low risk for subsequent breast cancer.","volume":"251","author":"Kaas","year":"2010","journal-title":"Ann Surg"},{"key":"R76-5-20260317","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1245\/ASO.2004.05.018","article-title":". 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