Perception of screening and risk reduction surgeries in patients tested for a BRCA deleterious mutation.
BACKGROUND
Women at a high risk for breast cancer are offered choices for screening or prophylactic surgeries. The aim of this study was to evaluate opinions regarding screening and surgical strategies in high-risk women.


METHODS
Women at the authors' institution who received BRCA1 of 2 testing before July 2005 were sent a follow-up patient survey. The authors compared responses of women who tested positive for a deleterious mutation with those who tested negative. For those who expressed an opinion (agree vs disagree), a 2-sided Fisher exact test was used to compare responses.


RESULTS
A total of 540 surveys were sent, and 312 were returned (58%). Of these, 217 had breast cancer, and 86 women tested positive for a mutation. No BRCA+ women felt mammograms were difficult to get because of discomfort, whereas 5.4% of the BRCA- group did (P = .039). Seventy percent of BRCA+ women agreed that prophylactic mastectomy (PM) is the most effective means for reducing risk, compared with 40% of BRCA- women (P < .001). PM was felt to be the only way to reduce worry in 64.7% of BRCA+ and in 34.4% of BRCA- women (P < .001). PM was felt to be too drastic for 36.1% of BRCA+ and 40.5% of BRCA- women (P = .562). Difficulty in deciding between screening and PM occurred in 23.9% of BRCA+ and 12.5% of BRCA- women (P = .046). After excluding women with bilateral breast cancers, 81.0% of women who agreed that PM was best to reduce risk underwent a PM versus 19.1% of those who disagreed (P < .001). Of women who felt PM was the only way to reduce worry, 84.2% underwent PM. Only 15.8% of women who did not believe that it was the only way to decrease worry underwent PM (P < .001).


CONCLUSIONS
BRCA mutation carriers were more likely to believe PM to be the best way to reduce both risk and worry of breast cancer. High-risk women who agreed that PM was more likely to reduce risk and worry of breast cancer were more likely to proceed with this intervention.
Litton
Jennifer K
JK
Department of Breast Medical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA. jlitton@mdanderson.org
Westin
Shannon N
SN
Ready
Kaylene
K
Sun
Charlotte C
CC
Peterson
Susan K
SK
Meric-Bernstam
Funda
F
Gonzalez-Angulo
Ana M
AM
Bodurka
Diane C
DC
Lu
Karen H
KH
Hortobagyi
Gabriel N
GN
Arun
Banu K
BK
D001294:Attitude to Health; D001943:Breast Neoplasms / Q000235:genetics* / Q000601:surgery; D003657:Decision Making; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005817:Genetic Counseling; D005820:Genetic Testing; D006306:Health Surveys; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009154:Mutation; D010465:Perception; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires