Decision Analysis of Prophylactic Surgery or Screening for <i>BRCA1</i> Mutation Carriers: A More Prominent Role For Oophorectomy

Roosmalen, Mariëlle S. van; Verhoef, Lia C.G.; Stalmeier, Peep F. M.; Hoogerbrugge, Nicoline; Daal, W.A.J. van

doi:10.1200/jco.2002.08.035

Cited by 85 publications

(45 citation statements)

References 49 publications

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“…Fourth, long-term follow-up on the effects of the DA was not obtained because all mutation carriers eventually had received the DA. In the second part of our study, evaluating another DA, including trade-offs and a formal treatment advice derived from a decision model (Van Roosmalen et al, 2002), the follow-up of these mutation carriers will be continued. The brochure was based on the best knowledge available at that time and needs regular updates.…”

Section: Discussionmentioning

confidence: 99%

“…These treatment options have different risk -benefit profiles that women may value differently. The decision about optimal treatment depends on women's personal values for the health states after each of the treatment options (Van Roosmalen et al, 2002). In order to choose between screening and prophylactic surgery in a way that reflects their personal values, these women need to be prepared for decision-making by providing information on the treatment options and their risks and benefits.…”

mentioning

confidence: 99%

“…The DA consisted of a brochure and video to be viewed at home, providing information on screening and prophylactic surgery, and the physical, emotional, and social consequences. The present study is part of a larger shared decision-making study in which the impact of another DA, including trade-offs and a formal treatment advice derived from a decision model (Van Roosmalen et al, 2002), will be evaluated.…”

mentioning

confidence: 99%

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Randomised trial of a decision aid and its timing for women being tested for a BRCA1/2 mutation

Roosmalen¹,

Stalmeier²,

Verhoef³

et al. 2004

Br J Cancer

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The aim of the study was to evaluate the impact of a decision aid (DA) and its timing in women being tested for a BRCA1/2 mutation. Women with and without a previous history of cancer were included after blood sampling for genetic testing. The DA consisted of a brochure and video providing information on screening and prophylactic surgery. To evaluate the impact of the DA, women were randomised to the DA group (n ¼ 184), receiving the DA 2 weeks after blood sampling, or to the control group (n ¼ 184). To evaluate the impact of timing, mutation carriers who had received the DA before the test result (n ¼ 47) were compared to mutation carriers who received the DA after the test result (n ¼ 42). Data were collected on well-being, treatment choice, decision and information related outcomes. The impact of the DA was measured 4 weeks after blood sampling. The impact of timing was measured 2 weeks after a positive test result. The DA had no impact on well-being. Regarding decision related outcomes, the DA group more frequently considered prophylactic surgery (P ¼ 0.02) corroborated with higher valuations (P ¼ 0.04). No differences were found for the other decision related outcomes. Regarding information related outcomes, the DA group felt better informed (P ¼ 0.00), was more satisfied with the information (P ¼ 0.00), and showed more accurate risk perceptions. Timing of the DA had no effect on any of the outcomes. No interactions were found between the DA and history of cancer. In conclusion, women being tested for a BRCA1/2 mutation benefit from the DA on information related outcomes. Because timing had no effect, the DA is considered useful either before or after the test result.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Randomised trial of a decision aid and its timing for women being tested for a BRCA1/2 mutation

Roosmalen¹,

Stalmeier²,

Verhoef³

et al. 2004

Br J Cancer

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“…Taking this into account along with patient preferences, breast screening and PBSO may be the optimal management strategy. 60 Therefore, we think that our model underestimates the gains in life expectancy because of a genetic screening program. However, women may choose PBSO but forgo PM in favor of breast MRI, knowing that they achieve a significant reduction in the risk of breast cancer, and this could lead to increased costs.…”

Section: Limitationsmentioning

confidence: 99%

“…1 Improvement in life expectancy and cost-effectiveness of PM has been demonstrated in numerous studies, 42,54,[57][58][59][60] but the uptake of this procedure in unaffected women is low, only about 20% in American women. 23 To the extent that BRCA1/2 carriers identified through a population-based screening study would choose to undergo PM, the effect of a screening program should be more effective in terms of life expectancy and costs.…”

Section: Limitationsmentioning

confidence: 99%

Cost-effectiveness of population-based BRCA1/2 testing and ovarian cancer prevention for Ashkenazi Jews: A call for dialogue

Rubinstein

Jiang

Dellefave

et al. 2009

Genetics in Medicine

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Purpose: About half of unaffected BRCA1/2 carriers have a negative family history, confounding efforts toward presymptomatic carrier identification. Ovarian cancer is preventable for known carriers but is otherwise highly lethal. Cost-effectiveness and gains in life expectancy are important factors in evaluating the desirability of population-based genetic screening, currently the only viable strategy to identify carriers with unrevealing family histories. Methods: Cost-utility analysis for a population-based genetic screening program offered to American Ashkenazi Jewish women aged 35-55 years measuring cancer incidence, life expectancy, and cost. Results: Our model predicts that a genetic screening program would result in 2811 fewer cases of ovarian cancer, with a life expectancy gain of 1.83 quality-adjusted life years among carriers. At a cost of $460 for founder mutation testing, the cost of the program is $8300 (discounted) per year of quality-adjusted life gained. Conclusion:In populations with a high prevalence of BRCA1/2 founder mutations, genetic screening may be cost-effective when compared with recommended public health interventions such as mammographic screening. We advocate the initiation of a dialogue among Jewish stakeholders, genetics professionals, and public health leaders to determine whether a population-based BRCA1/2 genetic screening program should be pursued. Genet Med 2009:11(9):629 -639. Key Words: BRCA1, BRCA2, decision analysis, ovarian carcinoma, population-based genetic screeningA n inherited predisposition to hereditary breast and ovarian cancer should be heralded by a strong cancer family history, but surprisingly often, it is not. Incomplete penetrance, sexlimited expression, limited family structure, and incomplete family history information all contribute to the frequent observation of hereditary cancer cases, which lack premonitory clues. Female BRCA1/2 carriers who are unaware of their genetic status cannot undertake recommended measures such as early mammography and breast magnetic resonance imaging (MRI) or avail themselves of risk-reducing salpingo-oophorectomy after completion of childbearing. Women with nonscreen detected, early-onset breast cancer and those who develop ovarian cancer can be expected to face much higher morbidity and mortality than if they were undergoing high-risk management.An underlying assumption in clinical cancer genetics is that by maximizing the efficiency of the referral pipeline through such means as physician and patient education and computerized family history tools, most unaffected BRCA1/2 carriers could be identified before developing cancer. High-risk management could then be instituted in a family-centered manner to reduce the cancer burden. Although this holds true for families with recognizable features of hereditary cancer, several studies suggest that about half of all BRCA1/2 families cannot be identified using this approach. [1][2][3][4][5][6][7][8] BRCA1/2 mutation prevalence rates have been measured in several population-based...

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Cost-effectiveness of Screening BRCA1/2 Mutation Carriers With Breast Magnetic Resonance Imaging

Plevritis¹,

Kurian²,

Sigal³

et al. 2006

JAMA

243

193

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Decision Analysis of Prophylactic Surgery or Screening for BRCA1 Mutation Carriers: A More Prominent Role For Oophorectomy

Abstract: PMPO is the most effective strategy to prolong life. However, if patient preferences were taken into account, BSPO tends to be a better strategy in most women at medium risk or in young women at high risk when PO was performed before age 40.

Cited by 85 publications

References 49 publications

Randomised trial of a decision aid and its timing for women being tested for a BRCA1/2 mutation

Randomised trial of a decision aid and its timing for women being tested for a BRCA1/2 mutation

Cost-effectiveness of population-based BRCA1/2 testing and ovarian cancer prevention for Ashkenazi Jews: A call for dialogue

Cost-effectiveness of Screening BRCA1/2 Mutation Carriers With Breast Magnetic Resonance Imaging

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