Risk of Peritoneal Carcinomatosis After Risk-Reducing Salpingo-Oophorectomy:A Systematic Review and Individual Patient Data Meta-Analysis

PURPOSEAfter risk-reducing salpingo-oophorectomy (RRSO), BRCA1/2 pathogenic variant (PV) carriers have a residual risk to develop peritoneal carcinomatosis (PC). The etiology of PC is not yet clarified, but may be related to serous tubal intraepithelial carcinoma (STIC), the postulated origin for high-grade serous cancer. In this systematic review and individual patient data meta-analysis, we investigate the risk of PC in women with and without STIC at RRSO.METHODSUnpublished data from three centers were supplemented by studies identified in a systematic review of EMBASE, MEDLINE, and the Cochrane library describing women with a BRCA-PV with and without STIC at RRSO until September 2020. Primary outcome was the hazard ratio for the risk of PC between BRCA-PV carriers with and without STIC at RRSO, and the corresponding 5- and 10-year risks. Primary analysis was based on a one-stage Cox proportional-hazards regression with a frailty term for study.RESULTSFrom 17 studies, individual patient data were available for 3,121 women, of whom 115 had a STIC at RRSO. The estimated hazard ratio to develop PC during follow-up in women with STIC was 33.9 (95% CI, 15.6 to 73.9), P <.001) compared with women without STIC. For women with STIC, the five- and ten-year risks to develop PC were 10.5% (95% CI, 6.2 to 17.2) and 27.5% (95% CI, 15.6 to 43.9), respectively, whereas the corresponding risks were 0.3% (95% CI, 0.2 to 0.6) and 0.9% (95% CI, 0.6 to 1.4) for women without STIC at RRSO.CONCLUSIONBRCA-PV carriers with STIC at RRSO have a strongly increased risk to develop PC which increases over time, although current data are limited by small numbers of events

Are the Unskilled Really That Unaware? Understanding Seemingly Biased Self-Assessments

The so-called unskilled-and-unaware problem was experimentally identified a decade ago: The unskilled are seemingly afflicted by a double curse because they also seem unaware of their (relative) lack of skills. Numerous authors have elaborated on this problem – experimentally as well as theoretically. In this paper, we report on the results of three experiments (one field, two laboratory) through which we test a theoretical model and some informal extensions. Specifically, we examine the impact of general information and specific information (feedback) on the quality of self-assessment (“calibration”) in various tasks and under various conditions. Overconfidence behavior initially prevails in almost all settings. We find a strong positive effect of general information on calibration, and show that calibration improves more when feedback is provided. In our experiments, it is the unskilled who improve their calibration the most.Calibration, judgement errors, unskilled, unaware, metacognition, experiment

Are the unskilled really that unaware? An alternative explanation

In a series of articles and manuscripts (e.g., [Kruger, J., & Dunning, D. (1999). Unskilled and unaware of it: How difficulties in recognizing one's own incompetence lead to inflated self-assessment. Journal of Personality and Social Psychology, 77, 1121-1134; Dunning, D., Johnson, K., Ehrlinger, J., & Kruger, J. (2003). Why people fail to recognize their own incompetence. Current Directions in Psychological Science, 12, 83-87; Ehrlinger, J., Johnson, K., Banner, M., Kruger, J., & Dunning, D. (2008). Why the unskilled are unaware: Further exploration of (absent) self-insight among the incompetent. Organizational Behavior and Human Decision Processes, 105, 98-121.]), Dunning, Kruger and their collaborators argued that the unskilled lack the metacognitive ability to realize their incompetence. We propose that the alleged unskilled-and-unaware problem - rather than being one of biased judgements - is a signal extraction problem that differs for the skilled and the unskilled. Specifically, the unskilled face a tougher inference problem than the skilled.Calibration Judgement errors Unskilled Unaware Metacognition