Attitudes to prophylactic surgery and chemoprevention in Australian women at increased risk for breast cancer.
BACKGROUND
Because of the uncertain efficacy of breast cancer screening in women at increased risk of developing breast cancer, bilateral prophylactic oophorectomy and mastectomy are considered management options for high-risk women. Data on the attitudes to prophylactic strategies of high-risk women who have not attended specialist clinics are needed to ascertain the need for patient education and provide the basis for planning of support services.


METHODS
Three hundred seventy-one women unaffected by cancer and with unknown mutation status from families with a dominantly inherited susceptibility to breast cancer, recruited through a large Australian population-based, epidemiological study, were assessed using a mailed self-administered questionnaire with validated measures of psychological outcome.


RESULTS
Sixteen percent of women reported considering prophylactic mastectomy, and 1% had already had the procedure. Among women with a family history of breast/ovarian cancer, 33% had considered and 5% had already had a prophylactic oophorectomy. Twenty-three percent of women reported considering taking tamoxifen if it were shown to prevent breast cancer. Consideration of prophylactic oophorectomy (OR = 1.51 for a 10% change in perceived risk, 95% CI 1.14-1.99, p = 0.0045) and tamoxifen (OR = 1.14 for a 10% change in perceived risk, 95% CI 1.002-1.30, p = 0.047) were positively associated with perceived cancer risk.


CONCLUSIONS
Attitudes to prophylactic surgery and psychological distress levels in high-risk women participating in an epidemiological study appear to be comparable to those of women attending familial cancer clinics and indicate that women attending high-risk clinics may be representative of the larger population of women at increased risk.
Department of Medical Oncology, Prince of Wales Hospital, Randwick New South Wales 2031, Sydney, Australia. b.meiser@unsw.edu.au
B
B
Meiser
P
P
Butow
M
M
Price
B
B
Bennett
G
G
Berry
K
K
Tucker
D000328:Adult; D001294:Attitude to Health; D001315:Australia / Q000453:epidemiology; D001943:Breast Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000235:genetics / Q000517:prevention & control* / Q000523:psychology*; D018890:Chemoprevention / Q000523:psychology; D016021:Epidemiologic Studies; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000523:psychology; D008875:Middle Aged; D012307:Risk Factors; D011795:Surveys and Questionnaires