title: Long-term outcomes of BRCA1/BRCA2 testing: risk reduction and surveillance.
abstract: BACKGROUND
  For BRCA1/BRCA2 gene testing to benefit public health, mutation carriers must initiate appropriate risk management strategies. There has been little research examining the long-term use and prospective predictors of the full range of risk management behaviors among women who have undergone BRCA1/2 testing. We evaluated long-term uptake and predictors of risk-reducing mastectomy (RRM), risk-reducing bilateral salpingo-oophorectomy (RRBSO), chemoprevention, and cancer screening among women at a mean of 5.3 years after testing.
  
  
  METHODS
  The study participants comprised 465 women who underwent BRCA1/2 testing. Prior to genetic counseling, we measured family/personal cancer history, sociodemographics, perceived risk, cancer-specific distress, and general distress. We contacted patients at a mean of 5.3 years after testing to measure use of RRM, RRBSO, chemoprevention, and breast and ovarian cancer screening.
  
  
  RESULTS
  Among participants with intact breasts and/or ovaries at the time of testing, BRCA1/2 carriers were significantly more likely to obtain RRM (37%) and RRBSO (65%) compared with women who received uninformative (RRM, 6.8%; RRBSO, 13.3%) or negative (RRM, 0%; RRBSO, 1.9%) results. Among carriers, precounseling anxiety was associated with subsequent uptake of RRM. RRO was predicted by age. Carriers were also more likely have used breast cancer chemoprevention and have undergone magnetic resonance imaging screening.
  
  
  CONCLUSIONS
  This prospective evaluation of the uptake and predictors of long-term management outcomes provides a clearer picture of decision making in this population. At a mean of 5.3 years after testing, more than 80% of carriers had obtained RRM, RRBSO, or both, suggesting that BRCA1/2 testing is likely to have a favorable effect on breast and ovarian cancer outcomes.
authors: Department of Oncology, Cancer Control Program, Jess and Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20007, USA. schwartm@georgetown.edu
authors: Marc D
authors: MD
authors: Schwartz
authors: Claudine
authors: C
authors: Isaacs
authors: Kristi D
authors: KD
authors: Graves
authors: Elizabeth
authors: E
authors: Poggi
authors: Beth N
authors: BN
authors: Peshkin
authors: Christy
authors: C
authors: Gell
authors: Clinton
authors: C
authors: Finch
authors: Scott
authors: S
authors: Kelly
authors: Kathryn L
authors: KL
authors: Taylor
authors: Lauren
authors: L
authors: Perley
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000175:diagnosis / Q000235:genetics* / Q000517:prevention & control* / Q000601:surgery; D055088:Early Detection of Cancer; D005192:Family Health; D005260:Female; D005500:Follow-Up Studies; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005820:Genetic Testing; D006579:Heterozygote; D006801:Humans; D008279:Magnetic Resonance Imaging; D008408:Mastectomy; D008875:Middle Aged; D009154:Mutation; D017063:Outcome Assessment, Health Care; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000517:prevention & control* / Q000601:surgery; D010052:Ovariectomy; D010349:Patient Compliance; D011446:Prospective Studies; D040242:Risk Reduction Behavior; D058994:Salpingectomy
chemical_list: D000970:Antineoplastic Agents