Purpose Risk-reducing salpingo-oophorectomy (RRSO) and ovarian cancer screening (OCS) are alternative risk management strategies available to women at increased genetic risk of ovarian cancer. However, because the utility of these interventions is unclear, the choice between them is difficult and dependent on numerous factors in ways that are incompletely understood.

Methods We analyzed factors associated with decisions between RRSO and OCS in 546 women participating in GOG-199, a large international, multi-institution, non-randomized prospective cohort study evaluating outcomes of RRSO and OCS in high-risk women. Several sociodemographic, health-related, and psychological factors were ascertained at the time participants made their decisions between RRSO and OCS. Descriptive, univariate, and multivariate logistic regression analyses were performed to examine associations between these factors and women's decisions.

Results Factors positively associated (p<.05) with the choice of RRSO included advice-seeking from gynecologic surgeons (OR 7.3, 95%CI: 3.7-14.4) and laypersons (OR 1.4, 95%CI: 1.1-1.6), greater perceived efficacy of RRSO (OR 4.9, 95% CI: 2.9-8.1), older age (OR 3.2, 95% CI: 1.5-6.5), patient-known BRCA1/2 mutation positivity (OR 3.1, 95% CI: 1.2-7.7), and greater concern about harms of surgery (OR 2.4, 95% CI: 1.3-4.4). Factors negatively associated (p<.05) with the choice of RRSO included higher education (OR 0.3, 95% CI: 0.1-0.8), current oral contraceptive use (OR 0.3, 95% CI: 0.1-0.9), greater concern about life disruption associated with surgery (OR 0.4, 95% CI: 0.2-0.8), greater perceived efficacy of OCS (OR 0.5, 95% CI: 0.4-0.6), greater subjective ambiguity about cancer risk (OR 0.7, 95% CI: 0.5-0.9), and monitoring personality style (OR 0.9, 95% CI: 0.8-0.9).

Conclusions Various factors are associated with high-risk women's decisions between RRSO and OCS, and their potential influence on decision-making raises important issues for clinical practice and future research.