Preferences for breast cancer prevention among women with a BRCA1 or BRCA2 mutation

Hereditary Cancer in Clinical Practice

Alexander Liede¹  Henry T. Lynch²  Carrie Snyder³  Sue Friedman⁴  D. Gareth Evans⁵  Joshua Posner⁶  Carol A. Mansfield⁶  Geoffrey J. Lindeman⁷  Kelly A. Metcalfe⁸  Steven A. Narod⁸ 

[1] AbbVie Inc, Dublin, Ireland;Creighton University, Omaha, NE, USA;Creighton University, Omaha, NE, USA;CHI Health Creighton University Medical Center, Omaha, NE, USA;Facing Our Risk of Cancer Empowered (FORCE) Advocacy Organization, Tampa, Florida, USA;Manchester Centre for Genomic Medicine, MAHSC, Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK;RTI Health Solutions, Research Triangle Park, PO Box 12194, 3040 Cornwallis Road, 27709-12194, Durham, NC, USA;The Royal Melbourne Hospital, Parkville, Australia;Peter MacCallum Cancer Centre, Melbourne, VIC, Australia;The Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, Australia;The University of Melbourne, Parkville, VIC, Australia;Women’s College Hospital, University of Toronto, Toronto, Canada;

关键词: BRCA1;    BRCA2;    High-risk women;    Risk-reducing surgeries;    Prevention;    Survey;    Preferences;    Choices;    Unaffected women;    International study;   

DOI  :  10.1186/s13053-020-00152-z

来源: Springer

【 摘 要 】

BackgroundWomen with a BRCA1 or BRCA2 mutation have high lifetime risks of developing breast and ovarian cancer. The decision to embark on risk reduction strategies is a difficult and personal one. We surveyed an international group of women with BRCA mutations and measured choices and sequence of breast cancer risk reduction strategies.MethodsWomen with a BRCA1/2 mutation and no previous cancer diagnosis were recruited from the US, Canada, the UK, Australia, and from a national advocacy group. Using an online survey, we asked about cancer-risk reduction preferences including for one of two hypothetical medicines, randomly assigned, and women’s recommendations for a hypothetical woman (Susan, either a 25- or 36-year-old). Sunburst diagrams were generated to illustrate hierarchy of choices.ResultsAmong 598 respondents, mean age was 40.9 years (range 25–55 years). Timing of the survey was 4.8 years (mean) after learning their positive test result and 33% had risk-reducing bilateral salpingo-oophorectomy (RRBSO) and bilateral mastectomy (RRBM), while 19% had RRBSO only and 16% had RRBM only. Although 30% said they would take a hypothetical medicine, 6% reported taking a medicine resembling tamoxifen. Respondents were 1.5 times more likely to select a hypothetical medicine for risk reduction when Susan was 25 than when Susan was 36. Women assigned to 36-year-old Susan were more likely to choose a medicine if they had a family member diagnosed with breast cancer and personal experience taking tamoxifen.ConclusionsWomen revealed a willingness to undergo surgeries to achieve largest reduction in breast cancer risk, although this would not be recommended for a younger woman in her 20s. The goal of achieving the highest degree of cancer risk reduction is the primary driver for women with BRCA1 or BRCA2 mutations in selecting an intervention and a sequence of interventions, regardless of whether it is non-surgical or surgical.

【 授权许可】

CC BY