Article Text

Download PDFPDF
Attitude of BRCA1/2 mutation carriers towards surgical risk reduction for breast, ovarian and uterine cancer: still much to be done
  1. Chen Nahshon1,2,
  2. Yakir Segev1,2,
  3. Meirav Schmidt1,2 and
  4. Ofer Lavie1,2
  1. 1Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
  2. 2Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
  1. Correspondence to Chen Nahshon, Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa 3436212, Israel; csarshalom{at}gmail.com

Abstract

Objective To study and quantify the attitude of BRCA1/2 mutation carriers towards surgical risk reduction procedures.

Methods This cross-sectional national study was conducted by distribution of an anonymous questionnaire on social media platforms and to BRCA1/2 carriers’ medical clinic.

Results 530 BRCA1/2 mutation carriers answered the survey. Risk reduction bilateral salpingo-oophorectomy was discussed with 447/489 (91%) of patients and performed in 260/489 (53%). Hormonal replacement therapy was discussed in 280/474 (59%) of patients. Addition of hysterectomy to risk reduction bilateral salpingo-oophorectomy was discussed in 129/481 (27%) of patients and performed in 44/443(10%). Age over 35 years at time of mutation detection was found to be significant in raising risk reduction bilateral salpingo-oophorectomy and hysterectomy performance rates. Risk reduction mastectomy was discussed in 390/471 (83%) of patients and performed in 156/471 (33%). In a multivariate analysis, BRCA1 mutation carriers (OR=1.66 (95% CI 1.07 to 2.57), p=0.024) and a personal cancer history leading to the mutation detection (OR=4.75 (95% CI 1.82 to 12.4), p=0.001) were found to be significant in increasing the likelihood of opting for risk reduction mastectomy. Additionally, highest risk reduction mastectomy performance rates were observed in the group of patients with a first-degree family history of breast cancer under the age of 50 years (OR=1.58 (95% CI 1.07 to 2.32), p=0.01).

Conclusions This study highlights the high performance rates of risk reduction bilateral salpingo-oophorectomy, while hysterectomy was added in 10%, and that despite high awareness and acceptance rates for risk reduction mastectomy, only 33% had the procedure. The data presented provides insights for the clinician counseling BRCA1/2 mutation carriers, with regards to adherence to recommendations, understanding their concerns towards treatment and management alternatives; and finally, to construct a personalized management medical plan.

  • hysterectomy
  • BRCA1 protein
  • BRCA2 protein

Data availability statement

Data are available upon reasonable request. Deidentified participant data are available by reasonable request from the corresponding author.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request. Deidentified participant data are available by reasonable request from the corresponding author.

View Full Text

Footnotes

  • Contributors CN: conceptualization, distribution, data collection, statistical analysis, writing - original draft, methodology, investigation, guarantor. YS: data collection, writing- review and editing, review. MS: validation, review. OL: conceptualization, writing-review and editing, methodology, investigation, supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.