title: Reasons for risk-reducing mastectomy versus MRI-screening in a cohort of women at high hereditary risk of breast cancer.
abstract: OBJECTIVE
  To determine the reasons that motivate women in a cohort of women under intensive surveillance for breast cancer to undergo risk-reducing mastectomy (RRM).
  
  
  METHODS
  Women with a BRCA1 or BRCA2 mutation who were enrolled in an MRI-based breast screening study were eligible to participate in this survey. A self-administered questionnaire was given to women who did, and who did not terminate annual MRI-based surveillance in order to undergo RRM. The questionnaire included information on family history, risk perception and satisfaction with screening. In addition, women were asked to provide the principal reason for their choice of having preventive surgery or not, and were asked about their satisfaction with this choice.
  
  
  RESULTS
  246 women without breast cancer participated in the study. Of these, 39 women (16%) elected to have RRM at some point after initiating screening. Although women who had a mother or sister with breast cancer were more likely to opt for RRM than were women with no affected first-degree relative (21% versus 10%) this did not reach statistical significance. Women who perceived their breast cancer risk to be greater than 50% were more likely to opt for RRM than were women who estimated their risk to be less than 50% (19% versus 6%). Fear of cancer was the most common reason cited for choosing to have RRM (38% of respondents) followed by having had a previous cancer, (25%), then concern over their children (16%).
  
  
  CONCLUSIONS
  Among women with a BRCA mutation who are enrolled in an MRI-based screening program, a high perception of personal breast cancer risk and a history of breast cancer in a first-degree relative are predictors of the decision to have RRM.
authors.affiliation: Familial Cancer Program, Odette Cancer Centre, Canada.
authors.forename: Iman
authors.initials: I
authors.lastname: Haroun
authors.forename: Tracy
authors.initials: T
authors.lastname: Graham
authors.forename: Aletta
authors.initials: A
authors.lastname: Poll
authors.forename: Ping
authors.initials: P
authors.lastname: Sun
authors.forename: Kimberley
authors.initials: K
authors.lastname: Hill
authors.forename: Eleanor
authors.initials: E
authors.lastname: Weitzner
authors.forename: Steven
authors.initials: S
authors.lastname: Narod
authors.forename: Ellen
authors.initials: E
authors.lastname: Warner
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000517:prevention & control* / Q000523:psychology; D002755:Choice Behavior; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D008279:Magnetic Resonance Imaging; D008408:Mastectomy / Q000523:psychology*; D008875:Middle Aged; D017060:Patient Satisfaction; D011322:Primary Prevention; D011446:Prospective Studies; D012306:Risk; D057566:Self Report