Does preventive oophorectomy increase the risk of depression in BRCA mutation carriers?

Abstract

OBJECTIVE:

BRCA mutation carriers are advised to undergo bilateral salpingo-oophorectomy to prevent ovarian cancer. The abrupt hormonal withdrawal associated with early surgical menopause has been shown to increase the risk of depression and anxiety among women in the general population. The impact in women with a BRCA1 or BRCA2 mutation is not known.

METHODS:

We undertook a matched prospective study of BRCA mutation carriers to evaluate the impact of oophorectomy on self-reported initiation of antidepressant use. We identified women with no personal history of cancer or depression and prospectively evaluated the frequency of self-reported medication use after surgery. Each exposed participant (oophorectomy) was randomly matched to a control participant (no oophorectomy) according to year of birth (within 3 years), BRCA mutation type (BRCA1 or BRCA2), and country of residence (Canada, United States, Poland). A total of 506 matched sets were included. We estimated the odds ratio (OR) and 95% confidence intervals (CIs) of antidepressant use (ever/never) following preventive oophorectomy in the entire study population and stratified by age at oophorectomy and by use of hormone therapy.

RESULTS:

Oophorectomy was not associated with more frequent antidepressant use among BRCA mutation carriers (OR = 0.46; 95% CI 0.22-0.96). We observed reductions in the odds of antidepressant medication use among women who underwent oophorectomy before the age of 50 years (OR = 0.33; 95% CI 0.14-0.78) and among those who initiated hormone therapy use after oophorectomy (OR = 0.35; 95% CI 0.14-0.90). Findings were similar when the analysis was based on self-reported depression (rather than antidepressant use).

CONCLUSIONS:

Although based on a small number of women, these findings suggest that oophorectomy does not increase psychological distress among women at an elevated risk of ovarian cancer.

• Authors: Joanne Kotsopoulos, Jacek Gronwald, Jan Lubinski, Jeanna McCuaig, Henry T Lynch, Susan L Neuhausen, William D Foulkes, Jeffrey N Weitzel, Leigha Senter, Nadine Tung, Charis Eng, Beth Karlan, Ping Sun, Steven A Narod, Hereditary Breast Cancer Clinical Study Group
• Journal: Menopause (New York, N.Y.) (Menopause) Vol. 27 Issue 2 Pg. 156-161 (02 2020) ISSN: 1530-0374 [Electronic] United States
• PMID: 31644510 (Publication Type: Evaluation Study, Journal Article)

Chemical References

• Antidepressive Agents
• BRCA1 Protein
• BRCA1 protein, human
• BRCA2 Protein
• BRCA2 protein, human

Topics

• Adult
• Antidepressive Agents (therapeutic use)
• BRCA1 Protein (genetics)
• BRCA2 Protein (genetics)
• Canada (epidemiology)
• Depression (drug therapy, epidemiology, etiology)
• Female
• Genetic Predisposition to Disease (genetics, psychology)
• Humans
• Middle Aged
• Mutation
• Odds Ratio
• Ovarian Neoplasms (genetics, prevention & control)
• Poland (epidemiology)
• Prophylactic Surgical Procedures (psychology)
• Prospective Studies
• Salpingo-oophorectomy (psychology)
• United States (epidemiology)