(005) A Systematic Review of Preventative BRCA Surgeries and Sexual Function Outcomes
Authors: Belda R , Morgan O , Chirivella I , Schnur J , Cano A 
Published: May 2023

Abstract

Introduction
BRCA 1 and 2 genes increase a patient’s risk for developing cancer of breast and ovarian origin. There are two methods of preventative care offered to BRCA-positive patients: prophylactic surgery or high risk screening for cancer accompanied by endocrine therapy. Preventative surgeries for BRCA-positive patients – bilateral salpingo-oophorectomy (BSO) and mastectomy - have been linked to decreased sexual function and dyspareunia. A patient’s decision whether or not to undergo preventive surgery as opposed to high risk screening (with or without hormone therapy) is heavily reliant on the advice received from their health care providers. The association of risk-reducing mastectomy and BSO with quality of life, including postoperative dyspareunia, should be taken into account when conducting shared decision-making with patients.

Objective
The objective of this systematic review is to assemble and analyze findings related to patient reported sexual function after these surgeries, to see if and how either surgery affects sexual dysfunction from patient baseline, and to compare the effects the two surgical procedures have on sexual function and whether these effects can be mitigated with hormone replacement therapy.

Methods
A literature review using Pubmed, Embase and MEDLINE databases from inception through January 25, 2022 was conducted. Included in the literature search were any form of observational study, clinical trial or article type. Conference abstracts were also included. To be included, studies had to meet an a priori list of Medical Subject Headings (MeSH) terms “BRCA” AND “sexual dysfunction” OR “dyspareunia”.

Results
The search yielded 13 results, of which seven reported sufficient data for systematic review. Participant numbers ranged from 15 to 804. Sexual dysfunction and dyspareunia were measured via both validated and investigator-generated surveys, three studies used the Female Sexual Function Index (2 BSO, 1 breast) and 2 of the studies used the Sexual Activity Questionnaire (both BSO). All of the studies, no matter the survey metric, found there to be significant sexual dysfunction with either BSO or mastectomy post surgery. All but one of the studies found that hormone replacement therapy was not show a significant improvement in sexual function, and all of the studies reported that sexual function post op could not reach baseline level with therapy. Menopausal status was not a significant moderator. No studies found preventative screenings to have an effect on sexual dysfunction or dyspareunia, and future studies could look into this group as a possible study control.

Conclusions
To our knowledge this is the first systematic review to incorporate the effects of both risk reducing mastectomies and BSO on sexual function among BRCA patients. The data can help decision making for BRCA positive patients and clinicians choosing between surgeries and high risk screening. Patients should be properly informed and counseled about dyspareunia before deciding to undergo irreversible procedures, and as part of shared decision making on which prevention approach is the best fit for their goals and preferences.

Disclosure
No