title: Risk-reducing mastectomy in BRCA1/2 mutation carriers: factors influencing uptake and timing.
abstract: BACKGROUND
  Strategies in case of high risk of breast cancer in BRCA1/2 mutation carriers are either intensive breast cancer screening or risk-reducing mastectomy (RRM). Both options have a high physical and psychosexual impact. The aim of this study is to investigate who chooses when to undergo RRM.
  
  
  METHODS
  BRCA1/2 mutation carriers have been prospectively registered at the family cancer clinic between 1994 and 2011. Analyses were performed to assess the relation between characteristics of the BRCA1/2 mutation carriers and an earlier decision for RRM.
  
  
  RESULTS
  A cumulative percentage of 35.6% of all women chose to undergo RRM within the first five years after disclosure of DNA test results. Women needed less time to choose for RRM measured from the first visit, if they were younger than 50 years of age (hazard ratio (HR)=2.67, 95% confidence interval (CI)=1.30-5.48) or had a mother who had had breast cancer (HR=1.51 95% CI=1.04-2.18). Also, women needed less time to choose for RRM in case of a previous breast cancer (HR=2.25, 95% CI=1.55-3.27). After a previous unilateral therapeutic mastectomy as a treatment for breast cancer, women needed less time to choose for RRM of the contralateral breast (HR=2.69, 95% CI=1.29-5.62) compared to women who had had breast-conserving therapy.
  
  
  CONCLUSIONS
  BRCA1/2 mutation carriers aged under 50, having a mother with breast cancer, who had previous unilateral breast cancer and previous unilateral therapeutic mastectomy chose more often and earlier for RRM.
authors.affiliation: Departments of Epidemiology, University Medical Center, University of Groningen, Groningen, The Netherlands. Electronic address: cmg.driel@umcg.nl.
authors.forename: Catheleine M
authors.initials: CM
authors.lastname: van Driel
authors.affiliation: Reconstructive Surgery, University Medical Center, University of Groningen, Groningen, The Netherlands.
authors.forename: Yassir
authors.initials: Y
authors.lastname: Eltahir
authors.affiliation: Surgery, University Medical Center, University of Groningen, Groningen, The Netherlands.
authors.forename: Jakob
authors.initials: J
authors.lastname: de Vries
authors.affiliation: Medical Psychology, University Medical Center, University of Groningen, Groningen, The Netherlands.
authors.forename: Jan P
authors.initials: JP
authors.lastname: Jaspers
authors.affiliation: Genetics and University Medical Center, University of Groningen, Groningen, The Netherlands.
authors.forename: Jan C
authors.initials: JC
authors.lastname: Oosterwijk
authors.affiliation: Gynaecology, University Medical Center, University of Groningen, Groningen, The Netherlands.
authors.forename: Marian J
authors.initials: MJ
authors.lastname: Mourits
authors.affiliation: Departments of Epidemiology, University Medical Center, University of Groningen, Groningen, The Netherlands. Electronic address: g.h.de.bock@umcg.nl.
authors.forename: Geertruida H
authors.initials: GH
authors.lastname: de Bock
mesh_terms: D001943:Breast Neoplasms / Q000235:genetics / Q000523:psychology*; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D008408:Mastectomy / Q000523:psychology*; D008875:Middle Aged; D040242:Risk Reduction Behavior; D013997:Time Factors
keywords: Breast neoplasms/prevention & control; Genes, BRCA1; Genes, BRCA2; Mastectomy; Risk reduction behavior; Time factors