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

Kotsopoulos J1,2, Gronwald J3, Lubinski J3, McCuaig J4, Lynch HT5, Neuhausen SL6, Foulkes WD7, Weitzel JN8, Senter L9, Tung N10, Eng C11, Karlan B12, Sun P1, Narod SA1,2; Hereditary Breast Cancer Clinical Study Group.

Author information

1: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
2: Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
3: Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Szczecin, Poland.
4: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Ontario, Canada.
5: Department of Preventive Medicine and Public Health, Creighton University School of Medicine, Omaha, NE.
6: Division of Biomarkers of Early Detection and Prevention, Department of Population Science, City of Hope, Duarte, CA.
7: Program in Cancer Genetics, Department of Oncology and Human Genetics, McGill University, Montréal, Quebec, Canada.
8: Division of Clinical Cancer Genomics, Department of Population Sciences, City of Hope, Duarte, CA.
9: Division of Human Genetics, The Ohio State University Medical Center, Comprehensive Cancer Center, Columbus, OH.
10: Beth Israel Deaconess Medical Center, Boston, MA.
11: Genomic Medicine Institute, Cleveland Clinic, Cleveland, OH.
12: Department of Gynecology Oncology, Cedars Sinai Medical Center, Los Angeles, CA.

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.