Intentions for risk-reducing surgery among high-risk women referred for BRCA1/BRCA2 genetic counseling.
OBJECTIVE
Genetic testing for breast and ovarian cancer susceptibility is now part of routine clinical practice. Although rates of risk-reducing surgery following genetic testing have been increasing, little is known about attitudes toward risk-reducing surgery in women prior to genetic counseling and testing. This study examines correlates of patient intentions to undergo risk-reducing mastectomy (RRM) and risk-reducing oophorectomy (RRO).


METHODS
Participants were 696 women, ages 21-85, who sought breast cancer gene 1 and 2 (BRCA1/2) genetic counseling and had at least a 10% risk of carrying a mutation. The sample included women who were affected with breast or ovarian cancer and unaffected women with a known familial BRCA1/2 mutation. Participants completed a precounseling telephone questionnaire.


RESULTS
Prior to receiving genetic counseling, 23.3% of participants were considering RRM and 42.5% were considering RRO. Variables that were independently associated with RRM intentions were cancer-specific distress (OR = 1.14, 95% CI = 1.03-1.26), perceived risk of breast cancer (OR = 1.16, 95% CI = 1.05-1.28), education (OR = 1.76, 95% CI = 1.03-2.99), and age (OR = 0.96, 95% CI = 0.95-0.98). Predictors of RRO intentions were perceived risk for ovarian cancer (OR = 1.25, 95% CI = 1.14-1.37), perceived risk of carrying a BRCA1/2 mutation (OR = 1.74, 95% CI = 1.15-2.62), marital status (OR = 1.92, 95% CI = 1.34-2.76), and age (OR = 1.02, 95% CI = 1.00-1.03).


CONCLUSIONS
Because precounseling intentions predict subsequent risk-reducing surgery decisions, this study identified patient factors associated with surgical intentions. These factors reinforce the critical role for pretest genetic counseling in communicating accurate risk estimates and management options, and addressing psychosocial concerns, to facilitate informed decision making regarding RRM and RRO.
Lombardi Comprehensive Cancer Center/Georgetown University, Oncology, Washington, DC, USA.
Angie
A
Tong
Scott
S
Kelly
Rachel
R
Nusbaum
Kristi
K
Graves
Beth N
BN
Peshkin
Heiddis B
HB
Valdimarsdottir
Marie
M
Wood
Wendy
W
McKinnon
Judy
J
Garber
Shelley R
SR
McCormick
Lina
L
Jandorf
Marc D
MD
Schwartz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005817:Genetic Counseling / Q000523:psychology*; D020022:Genetic Predisposition to Disease / Q000523:psychology; D006801:Humans; D033182:Intention; D008408:Mastectomy / Q000523:psychology; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000523:psychology; D010052:Ovariectomy / Q000523:psychology; D065286:Prophylactic Surgical Procedures / Q000523:psychology*; D012017:Referral and Consultation; D055815:Young Adult
BRCA1; BRCA2; cancer; genetic counseling; oncology; risk-reducing mastectomy; risk-reducing oophorectomy