Decision-making around risk-reducing salpingo-oophorectomy among BRCA1/2-positive breast cancer patients: an exploratory mixed-methods study

Decision-making for risk-reducing salpingo-oophorectomy (RRSO) in BRCA-positive women is complex and influenced by both personal and psychosocial factors. Understanding these factors is essential to optimize patient-centered care. To explore RRSO decision-making, and describe RRSO decision status, among BRCA1/2-positive breast cancer patients, using an exploratory mixed-methods design in which qualitative findings drive interpretation. An exploratory, convergent mixed-methods study was conducted in 12 BRCA1/2-positive breast cancer women. Demographic and clinical variables were collected, and in-depth interviews with the same participants explored facilitators and barriers to RRSO. Categorical variables were summarized descriptively as frequencies and percentages; given the small sample, no inferential statistical testing was performed. Qualitative data were analyzed using thematic analysis, and qualitative and quantitative findings were integrated to develop the study's interpretation. Of 12 women, 7 (58%) opted for RRSO and 5 (42%) declined. Among those classified as having accepted/planned/completed RRSO, 3 (43%) carried BRCA1 and 4 (57%) carried BRCA2 pathogenic variants. RRSO acceptance/planning appeared more common among women aged ≥ 50 years and among those with 1–2 children (71%); these are descriptive trends only, as the sample was too small to test for associations with parity, education, employment, menopausal status, or family history. Key facilitators included awareness of cancer risk, family support, clinician recommendation, availability of minimally invasive or combined procedures, and prior treatment experience. Major barriers included concerns about the effects of surgical menopause on fertility, emotional wellbeing, and social and womanhood-related roles. The qualitative findings were consistent with and provided context for the descriptive patterns observed. RRSO decision-making is multifactorial, shaped by clinical and psychosocial factors. Personalized counseling, psychosocial support, decision aids and family-centered discussions are crucial to support informed choices.