Personalized Decision-Making in Risk-Reducing Surgery of the Ovaries.

Importance: Premenopausal women at familial or hereditary risk of ovarian cancer must weigh the risks and benefits of risk-reducing surgery. How they navigate this decision is not well understood. Objective: To assess the factors that motivate women to seek risk-reducing surgery for ovarian cancer. Design, Setting, and Participants: A discrete choice experiment enrolled premenopausal women seeking genetic testing for ovarian cancer risk at 2 tertiary-level cancer centers between August 2019 and January 2022. The experiment was conducted twice, once just prior to pretest counseling and again approximately 2 months later, after receiving results of genetic testing. Data analysis was conducted between June 2022 through January 2026. Main Outcomes and Measures: Conjoint analysis to assess factors influencing cancer-prevention decisions in women with risk of familial and hereditary ovarian cancer. Conjoint analysis was used to investigate which attributes were the most salient for women when considering treatment scenarios, with demographic and clinical data as modifiers. Participants were asked to choose between sets of randomly permuted scenarios specifying type of treatment, risk and age of ovarian cancer, risk of heart disease and osteoporosis, and features of menopause. Results: The participants included 355 women (median age, 37 years [range, 21-55 years]): 10.4% were Black, 7.6% were Hispanic, 85.1% were White, and 79.2% were college graduates. Family history of breast cancer was reported by 45.1%, ovarian cancer by 13.0%, and 11.3% had a personal history of breast cancer. Women preferred risk-reducing salpingo-oophorectomy (RRSO) to risk-reducing salpingectomy (RRS) or observation (odds ratio [OR], 1.24; 95% CI, 1.10-1.39). Differences in osteoporosis (OR, 0.83; 95% CI, 0.78-0.89) and heart disease (OR, 0.78; 95% CI, 0.73-0.84) risks affected choices. Preferences favored natural menopause (OR, 1.21; 95% CI, 1.11-1.33) and milder menopausal symptoms (OR, 0.66; 95% CI, 0.61-0.70). Family history of ovarian cancer increased preference for RRSO (OR, 1.26; 95% CI, 1.05-1.52), with a reduced effect in older women. Personal breast cancer history, ancestry, and genetic test results were not significant factors. Conclusions and Relevance: This survey study using conjoint analysis highlights the ability of women to weigh competing risks in reducing ovarian cancer. Counseling models that address decision complexity and incorporate personalized guidance are likely to improve the decision-making process.