Determinants of intention to undergo risk-reducing salpingo-oophorectomy among high-risk women for breast and ovarian cancer

To evaluate the intention of women at high risk for breast and ovarian cancer to undergo risk-reducing salpingo-oophorectomy (RRSO) after genetic testing, and to identify the main factors related to their decision-making. A prospective cohort study conducted at the high-risk outpatient clinic of the State University of Campinas (UNICAMP), including 355 high-risk women followed between November/2021 and October/2022. Participants answered clinical and sociodemographic questionnaires, underwent comprehensive genetic testing, and received pre- and post-test genetic counseling. The majority were white (60.3%), younger than 50 years (71.5%) with a mean age of 43 years, and premenopausal (61.6%). 355 patients were tested and 102 (28,7%) carried likely pathogenic or pathogenic variants, 59,3% in the BRCA 1 and 2 genes. Before testing, 42.5% expressed the intention to undergo RRSO, which decreased to 33.4% after counseling ( p < 0.05). The pre-test desire was more frequent in women aged 40–49 years, premenopausal, and with higher education ( p < 0.05). In multiple regression, the desire for risk-reducing mastectomy (OR ≈ 39, 95% CI 16,8–90,79, p < 0,0001), the presence of pathogenic variants in BRCA (OR 15,46, 95% CI 6.05–39.53, p < 0,0001), and a personal history of cancer (OR 2,69, 95% CI 1.52–4.75, p < 0,0001) were independently associated with the intention to undergo RRSO. Intention to undergo risk-reducing salpingo-oophorectomy was higher among younger and premenopausal women and those with higher educational attainment and was strongly associated with the desire to undergo risk-reducing mastectomy and a personal history of breast or ovarian cancer. Changes in intention after genetic testing reflected gene-specific risk stratification: intention was withdrawn predominantly among women without high-penetrance BRCA variants, whereas it was adopted primarily among those carrying pathogenic variants in high-risk genes. These findings underscore the importance of access to germline genetic testing to support individualized, risk-informed decision-making regarding high-complexity preventive strategies.