Cancer risk management strategies and perceptions of unaffected women 5 years after predictive genetic testing for BRCA1/2 mutations.
In a French national cohort of unaffected females carriers/non-carriers of a BRCA1/2 mutation, long-term preventive strategies and breast/ovarian cancer risk perceptions were followed up to 5 years after test result disclosure, using self-administered questionnaires. Response rate was 74%. Carriers (N=101) were younger (average age ± SD=37 ± 10) than non-carriers (N=145; 42 ± 12). There were four management strategies that comprised 88% of the decisions made by the unaffected carriers: 50% opted for breast surveillance alone, based on either magnetic resonance imaging (MRI) and other imaging (31%) or mammography alone (19%); 38% opted for either risk reducing salpingo-oophorectomy (RRSO) and breast surveillance, based on MRI and other imaging (28%) or mammography alone (10%). The other three strategies were: risk reducing mastectomy (RRM) and RRSO (5%), RRM alone (2%) and neither RRM/RRSO nor surveillance (6%). The results obtained for various age groups are presented here. Non-carriers often opted for screening despite their low cancer risk. Result disclosure increased carriers' short-term high breast/ovarian cancer risk perceptions (P ≤ 0.02) and decreased non-carriers' short- and long-term perceptions (P<0.001). During follow-up, high breast cancer risk perceptions increased with time among those who had no RRM and decreased in the opposite case; high ovarian cancer risk perceptions increased further with time among those who had no RRSO and decreased in the opposite case; RRSO did not affect breast cancer risk perceptions. Informed decision-making involves letting women know whether opting for RRSO and breast MRI surveillance is as effective in terms of survival as RRM and RRSO.
INSERM, U912, IRD, Institut Paoli-Calmettes, Marseille, France. claire.julian-reynier@inserm.fr
Claire
C
Julian-Reynier
Julien
J
Mancini
Emmanuelle
E
Mouret-Fourme
Marion
M
Gauthier-Villars
Valérie
V
Bonadona
Pascaline
P
Berthet
Jean-Pierre
JP
Fricker
Olivier
O
Caron
Elisabeth
E
Luporsi
Catherine
C
Noguès
D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005820:Genetic Testing; D007722:Health Knowledge, Attitudes, Practice; D006579:Heterozygote; D006801:Humans; D008279:Magnetic Resonance Imaging; D008408:Mastectomy; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000517:prevention & control*; D012308:Risk Management; D011795:Surveys and Questionnaires
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