title: Effects of false-positive cancer screenings and cancer worry on risk-reducing surgery among BRCA1/2 carriers.
abstract: OBJECTIVE
  Female BRCA1/2 mutation carriers are at increased risk of breast and ovarian cancer. Annual breast and semiannual ovarian cancer screening is recommended for early detection, which frequently leads to false-positive test results (FPTR). FPTR may influence cancer risk perceptions and worry, which in turn may affect an individual's decision to undergo risk-reducing bilateral salpingo-oophorectomy (RRSO) or risk-reducing bilateral mastectomy (RRBM). The purpose of this study was to examine: (a) the effect of false-positive breast and ovarian cancer screening test results on perceived cancer risk and cancer worry, and (b) the joint effects of FPTR, risk perceptions, and worry on the choice of risk-reducing surgery among BRCA1/2 mutation carriers undergoing an intensive cancer screening protocol.
  
  
  METHODS
  BRCA1/2 mutation carriers (N = 170) reported cancer risk perceptions and cancer worry during a prospective 4-year screening protocol (2001-2007) at the U.S. National Cancer Institute. FPTR and risk-reducing surgeries were objectively recorded.
  
  
  RESULTS
  FPTR at baseline were associated with transient elevations in worry; cumulative FPTR across the entire study were not associated with opting for risk-reducing surgery. However, cancer-specific worry was a strong predictor of surgery (RRSO: OR = 6.15; RRBM: OR = 4.27).
  
  
  CONCLUSIONS
  In women at inherited risk of breast and ovarian cancer, FPTR were not associated with large increases in cancer risk perception, cancer worry, or increased uptake of risk-reducing surgery. However, cancer-specific worry was an independent predictor of uptake of risk-reducing surgery and warrants consideration when counseling high-risk women regarding risk-reducing interventions.
authors.affiliation: Cancer Prevention Fellowship Program, Center for Cancer Training and Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute.
authors.forename: David B
authors.initials: DB
authors.lastname: Portnoy
authors.affiliation: Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute.
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Loud
authors.affiliation: Center for Outcomes Research and Evaluation, Maine Medical Center.
authors.forename: Paul K J
authors.initials: PK
authors.lastname: Han
authors.affiliation: Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute.
authors.forename: Phuong L
authors.initials: PL
authors.lastname: Mai
authors.affiliation: Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Greene
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000523:psychology; D055088:Early Detection of Cancer / Q000523:psychology*; D005189:False Positive Reactions; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006579:Heterozygote; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009154:Mutation; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000235:genetics / Q000523:psychology; D010052:Ovariectomy; D011446:Prospective Studies; D040242:Risk Reduction Behavior