Supplementary Table-1: Risk Reducing Salpingectomy followed by delayed oophorectomy in premenopausal women at high risk of familial tubal/ovarian cancer

1. How strongly do you agree with the hypothesis that a significant proportion of high grade serous cancers (HGSC) of the ovary probably originate from the fallopian tube?
Strongly Disagree Neither Agree Strongly
Disagree Agree nor Agree
Disagree
☐ ☐ ☐ ☐ ☐
2. Prior to filling this questionnaire, were you familiar with the concept of offering risk reducing salpingectomy (RRS) followed by delayed bilateral oophorectomy (DO) in pre-menopausal women at high risk of ovarian cancer who wish to delay/avoid risk-reducing salpingo-oophorectomy?
☐Yes ☐No
3. Do you agree or disagree with the following statement:
A significant proportion of premenopausal women at high risk of ovarian cancer decline risk reducing salpingo-oophorectomy (RRSO) due to their concerns regarding side effects and perceived risks of premature menopause.
Strongly Disagree Neither Agree Strongly
Disagree Agree nor Agree
Disagree
☐ ☐ ☐ ☐ ☐
4. Which of the effects of surgical menopause do you think influence pre-menopausal women when making a decision regarding risk reducing surgery? Please tick all that apply
☐Vasomotor symptoms ☐Negative impact on sexual functioning
☐Cognitive decline ☐Increased risk of other neurological ☐Osteoporosis disorders (dementia/Parkinson’s)
☐Potential survival impact ☐Increased cardiovascular risk
☐Loss of fertility ☐ Need for hormone replacement therapy until age 50
☐Other: (Please use free text for further comments)
5. What do you believe is the association between oophorectomy in high risk premenopausal women and subsequent breast cancer risk ( in those who have not had breast cancer)?
☐ No association with breast cancer risk
☐ 25% reduction in breast cancer risk
☐50% reduction in breast cancer risk
☐75% reduction in breast cancer risk
☐Risk of breast cancer is increased
☐Not sure
6. Which of the following factors are potential barriers to offering risk reducing salpingectomy and delayed oophorectomy compared to RRSO (risk reducing salpingo-oophorectomy)?
a)  Increased surgical morbidity as two procedures are needed
☐Yes ☐No ☐Not sure
b)  The benefit of reduction in ovarian cancer risk has only been proven with RRSO
☐Yes ☐No ☐Not sure
c)  The precise level of ovarian cancer risk reduction that will be obtained is not certain/established
☐Yes ☐No ☐Not sure
d)  Some patients may not undergo delayed oophorectomy, following bilateral salpingectomy and will develop ovarian cancer
☐Yes ☐No ☐Not sure
e)  Loss of benefit of reduction in breast cancer risk
☐Yes ☐No ☐Not sure
f)  May cause confusion and additional stress for women who are already making many challenging decisions and coming to terms with their risk
☐Yes ☐No ☐Not sure
g)  Cost effectiveness is not established
☐Yes ☐No ☐Not sure
h)  Long term effect of salpingectomy on ovarian function is unknown
☐Yes ☐No ☐Not sure
i)  Other (please use free text for further comments)
7. In which of the following pre-menopausal women would you support offering risk reducing salpingectomy (RRS) followed by a delayed oophorectomy (DO)? Please tick all that apply
Yes No Not sure
BRCA1 carriers ☐ ☐ ☐
BRCA2 carriers ☐ ☐ ☐
RAD51 carriers ☐ ☐ ☐
Unknown mutation status estimated ☐ ☐ ☐
≥10%life time risk of ovarian cancer
8. Please indicate whether you agree or disagree with the following statements regarding the introduction of risk reducing salpingectomy (RRS) followed by a delayed oophorectomy (DO) in pre-menopausal women at high risk of familial ovarian cancer.
Strongly
Agree / Disagree / Neither agree nor disagree / Agree / Strongly Agree
The current body of evidence is strong enough to introduce this proposal into routine clinical practice. / ☐ / ☐ / ☐ / ☐ / ☐
I would support offering this proposal to women who decline/wish to delay risk reducing bilateral salpingo-oophrectomy (RRSO). / ☐ / ☐ / ☐ / ☐ / ☐
Premenopausal women with a past history of breast cancer could be offered RRS and DO / ☐ / ☐ / ☐ / ☐ / ☐
This should only be offered within the context of a clinical trial / ☐ / ☐ / ☐ / ☐ / ☐
There should be a UK wide registry of all women undergoing risk reducing salpingectomy / ☐ / ☐ / ☐ / ☐ / ☐
9. Which of these options best describes your post or level of training?
☐Consultant ☐Genetic Counsellor
☐Subspecialty Fellow ☐Clinical Nurse Specialist
☐Specialist Trainee (ST) ☐Trainee Genetic Counsellor
☐Associate Specialist
☐Other: (Please specify)
10. Which of these options best describes your current field of work?
☐Cancer Genetics / Clinical Genetics ☐Medical Oncology
☐Surgical Gynaecological Oncology ☐Clinical Oncology
☐Pathology ☐Radiology
☐General Obstetrics & Gynaecology
☐Other: (Please specify)
11. How many years have you been in your chosen field of work? (Please state in numerical digits):
12. Which of these practice settings best describes your place of work?
☐Tertiary Cancer Centre ☐District General Hospital
☐Regional Genetics Centre ☐Community Setting
☐University Teaching Hospital ☐Non-NHS Private Practice
☐Other: (Please specify)
13. On an annual basis, approximately how many pre-menopausal women at high risk of familial ovarian cancer (e.g. BRCA1/2 carriers) do you encounter in your clinical practice?
☐None ☐51-100
☐<20 ☐>100
☐21-50
14. Please feel free to add any other comments.