Changes in Risk Tolerance for Ovarian Cancer Prevention Strategies during the COVID-19 Pandemic: Results of a Discrete Choice Experiment

Background: Prior to COVID-19, little was known about how risks associated with such a pandemic would compete with and influence patient decision making regarding cancer risk reducing medical decision making. We investigated how the pandemic affected preferences for medical risk-reducing strategies among women at elevated risk of breast or ovarian cancer.

Methods: We conducted a discrete choice experiment. Women about to undergo genetic testing and counseling at 2 medical centers participated. Enrollment occurred between 2019 and 2022, allowing us to investigate changes in preferences from before the pandemic to after the pandemic. Women chose from permuted scenarios that specified type of surgery, age of menopause, quality of menopausal symptoms, and risk of ovarian cancer, heart disease, or osteoporosis.

Results: A total of 355 women, with a median age of 36 y, participated. In 2019, women were less likely to choose prevention scenarios with higher ovarian cancer risk (odds ratio [OR] = 0.42 per 10-point increase in risk, 95% confidence interval [CI] 0.22-0.61). In June 2020, the effect of higher ovarian cancer risk scenarios on choice was attenuated (OR = 0.86, 95% CI 0.68-1.04), with the effect becoming more salient again by July 2021 (OR = 0.59, 95% CI 0.52-0.67) (P = 0.039 for test of temporal interaction). No other attribute demonstrated a temporal trend.

Conclusion: The risks associated with the COVID-19 pandemic may have attenuated the impact of risk of ovarian cancer on choice of risk-reducing prevention strategies for ovarian cancer. The maximum attenuation occurred at the beginning of the pandemic when access to risk-reducing surgery was most restricted. Our findings highlight how individuals evaluate competing health risks and adjust their uptake of cancer prevention strategies when faced with a future pandemic or similar global crisis.

Highlights: In this discrete choice experiment, women were much less likely to choose prevention scenarios that had higher ovarian cancer risk prior to the COVID-19 pandemic than after the pandemic.The attenuation of preferences may have persisted through 2022.COVID-19 may have altered the relative importance of factors that motivate women to undergo risk-reducing surgeries.