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Abstract
Objective
Despite
substantial survival benefits of risk-reducing mastectomy (RRM) and
risk-reducing bilateral salpingo-oophorectomy (RRBSO) among BRCA
mutation carriers, only a minority elect to undergo these procedures.
This study investigates factors that might influence decision making
regarding prophylactic surgeries among women with BRCA mutations.
Study Design
Unaffected
BRCA mutation carriers who were counseled at our center and either
underwent prophylactic surgery or participated in a high-risk
surveillance program at our institution from 1998 through 2010 were
included in the study. Medical records were reviewed and data collected
included age, family history, parity, mutation type, history of breast
biopsy or cosmetic surgery, and uptake of prophylactic surgeries.
Results
Among
136 unaffected women with BRCA mutations, uptake of RRM was 42% and
uptake of RRBSO was 52%. Family history of first- and second-degree
relatives being deceased from breast cancer was predictive of uptake of
RRM and of RRBSO (odds ratio [OR], 11.0; P = .005; and OR, 15.8; P = .023, respectively), and history of a mother lost to pelvic cancer was predictive of uptake of RRBSO (OR, 7.9; P = .001). Parity also predicted both RRM and RRBSO uptake (OR, 4.2; P = .001; and OR, 5.4; P
= .003, respectively). Age at the time of genetic testing and history
of breast biopsy or cosmetic surgery were not predictive of RRM uptake.
Conclusion
Perceptions
of cancer risk are heavily influenced by particular features of an
individual's family history and may be motivators in preventive surgery
more than actual cancer risk estimations themselves. Awareness of subtle
factors beyond the statistical risk for cancers is relevant when
counseling at-risk women.
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