title: Risk-reducing surgery in women with familial susceptibility for breast and/or ovarian cancer.
abstract: This multicentre study examined uptake of bilateral risk-reducing mastectomy (BRRM) and bilateral risk-reducing oophorectomy (BRRO) in women at increased risk for breast and/or ovarian cancer who had attended a familial cancer clinic (FCC) between January 1999 and June 2000. Eligible women (N=396), were mailed a questionnaire assessing: BRRM and BRRO details; risk perception; and anxiety. Family history, genetic testing and risk assessment were abstracted from medical records. Surgery was cross-tabulated with demographics, risk perception and anxiety with either Fisher's exact test or the exact form of the Mantel-Haenszel test (for ordinal factors) used to investigate for associations. Ordinal logistic regression was used with continuous-scale covariates. In total, 130 women were lost to follow-up leaving 266; of these 182 (68.4%) responded. Mean follow-up time was 3.73 years. The BRRM rate was 4.4%; with no difference found between moderate and high-risk groups. BRRM was associated with increasing numbers of affected relatives (P=0.025). BRRO was undertaken by 17.3%, more commonly in women older than 40 years of age (P=0.023) and with a BRCA1/2 mutation (P=0.017). Women who underwent BRRM (P=0.052) or BRRO (P<0.001) had a lower post-procedure risk perception than those who did not. During the timeframe of this study, risk-reducing surgery was undertaken by a small percentage of Australian women at increased risk for breast and/or ovarian cancer who attended FCCs. Family cancer history and mutation status were associated with uptake.
authors.affiliation: Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, and The University of Melbourne, Department of Medicine, St. Vincent's Hospital, Vic., Australia.
authors.forename: Yoland
authors.initials: Y
authors.lastname: Antill
authors.forename: John
authors.initials: J
authors.lastname: Reynolds
authors.forename: Mary-Anne
authors.initials: MA
authors.lastname: Young
authors.forename: Judy
authors.initials: J
authors.lastname: Kirk
authors.forename: Katherine
authors.initials: K
authors.lastname: Tucker
authors.forename: Tarli
authors.initials: T
authors.lastname: Bogtstra
authors.forename: Shirley
authors.initials: S
authors.lastname: Wong
authors.forename: Tracy
authors.initials: T
authors.lastname: Dudding
authors.forename: Juliana
authors.initials: J
authors.lastname: Di Iulio
authors.forename: Kelly-Anne
authors.initials: KA
authors.lastname: Phillips
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001315:Australia; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D008408:Mastectomy / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000523:psychology; D010052:Ovariectomy / Q000379:methods / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010375:Pedigree; D010465:Perception; D018570:Risk Assessment; D012307:Risk Factors