How medical choices influence quality of life of women carrying a BRCA mutation

Harmsen, Marline G.; Hermens, Rosella; Prins, Judith B.; Hoogerbrugge, Nicoline; Hullu, Joanne A. de

doi:10.1016/j.critrevonc.2015.07.010

Cited by 24 publications

(29 citation statements)

References 63 publications

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“…Previous studies among individuals with a BRCA pathogenic variants unaffected with cancer showed that general QOL was not permanently affected by their management choices [39]. Although frequent screening and the consequent need for additional testing to evaluate false-positive findings have been associated with elevated anxiety levels among high-risk women [24,25], we hypothesized that participating in an active, long-term screening program might decrease emotional distress by helping women feel proactive in their care and reassured by normal screening tests.…”

Section: Discussionmentioning

confidence: 96%

Prospective follow-up of quality of life for participants undergoing risk-reducing salpingo-oophorectomy or ovarian cancer screening in GOG-0199: An NRG Oncology/GOG study

Phuong

Huang

Wenzel

et al. 2020

Gynecologic Oncology

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Section: Discussionmentioning

confidence: 96%

Prospective follow-up of quality of life for participants undergoing risk-reducing salpingo-oophorectomy or ovarian cancer screening in GOG-0199: An NRG Oncology/GOG study

Phuong

Huang

Wenzel

et al. 2020

Gynecologic Oncology

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“…Another limiting factor is the magnitude and duration of the impact of prophylactic surgeries on women's QOL. Empirical studies present some contradicting evidence for the impact of a BM and BSO (Harmsen et al 2015). More importantly, women exhibit varying preferences about surgery feasibility and timing, reflecting individual differences in family planning, self-perception, and perceived risk of cancer.…”

Section: Limitationsmentioning

confidence: 98%

mentioning

confidence: 99%

Was Angelina Jolie Right? Optimizing Cancer Prevention Strategies Among BRCA Mutation Carriers

2017

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Female carriers of a BRCA1 or BRCA2 genetic mutation face significantly elevated risks of cancer, with 45%-65% of women developing breast cancer and 15%-39% developing ovarian cancer in their lifetimes. Prophylactic surgery options to reduce cancer risk include a bilateral mastectomy (BM), bilateral salpingo-oophorectomy (BSO), or both surgeries. No comprehensive model providing recommendations at which age to perform the surgeries to optimize quality-adjusted life years (QALYs) exists. Using available clinical data, we develop a Markov decision process model of a mutation carrier's health states and corresponding transitions, including age-dependent breast and ovarian cancer risk, distribution of each cancer subtype and stage, and mortality. We convert the problem to a linear program to solve for the optimal surgery sequence that maximizes the carrier's expected lifetime QALYs under varying assumptions about individual patient preferences on postsurgery quality of life, fertility considerations, advances in cancer screening or treatment, and others. Baseline results demonstrate that a QALY-maximizing sequence recommends BM between ages 30 and 60 and BSO after age 40. Surgeries are recommended later for BRCA2 mutation carriers, given their lower risk for both cancers compared to BRCA1 mutation carriers. We derive structural properties from the model and show that when a carrier has already undergone one surgery, there exists an optimal control limit beyond which performing the other surgery is always QALY maximizing.

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“…These symptoms of estrogen withdrawal are prevalent adverse effects for women after RRSO and may impact health‐related quality of life . When mastectomy is combined with RRSO, menopausal and quality of life symptoms appear to be amplified, perhaps due to the effect of altered body image . Fear of these symptoms can also influence previvors’ willingness to undergo risk‐reducing surgery as well as their postprocedure satisfaction with their decision …”

Section: The Role Of Mht In Women At Risk Of Developing Breast and Ovmentioning

confidence: 99%

“…[127][128][129][130] When mastectomy is combined with RRSO, menopausal and quality of life symptoms appear to be amplified, perhaps due to the effect of altered body image. 131 Fear of these symptoms can also influence previvors' willingness to undergo risk-reducing surgery as well as their postprocedure satisfaction with their decision. 128 Although MHT can mitigate the adverse effects of surgical menopause, previvors and physicians are often wary of its use due to perceived risks of cancer promotion.…”

Section: The Role Of Mht In Women At Risk Of Developing Breast and Ovmentioning

confidence: 99%

The role of menopausal hormone therapy in women with or at risk of ovarian and breast cancers: Misconceptions and current directions

Temkin

Mallen

Bellavance

et al. 2018

Cancer

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For women who are candidates for menopausal hormone therapy (MHT), estrogen can provide relief from symptomatic menopause, decrease rates of chronic illnesses, and improve health‐related quality of life. However, confusion surrounds the evidence regarding the impact of exogenous estrogen and progesterone on the breast and ovary. Available data regarding the risks of MHT (estrogen and/or progestin) related to the development of breast and ovarian cancer are often inconsistent or incomplete. Modern molecular and genetic techniques have improved our understanding of the heterogeneity of breast and ovarian cancer. This enhanced understanding of the disease has impacted our understanding of carcinogenesis. Treatment options have evolved to be more targeted toward hormonal therapy for certain subtypes of disease, whereas cytotoxic chemotherapy remains the standard for other histological and molecular subtypes. The role of MHT in the breast and ovarian cancer survivor, as well as women who are at high risk for the development of hereditary breast and ovarian cancer, remains controversial despite evidence that this treatment can improve quality of life and survival outcomes. Through this article, we examine the evidence for and against the use of MHT with a focus on women who have or are at high risk for breast and ovarian cancer.

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How medical choices influence quality of life of women carrying a BRCA mutation

Cited by 24 publications

References 63 publications

Prospective follow-up of quality of life for participants undergoing risk-reducing salpingo-oophorectomy or ovarian cancer screening in GOG-0199: An NRG Oncology/GOG study

Prospective follow-up of quality of life for participants undergoing risk-reducing salpingo-oophorectomy or ovarian cancer screening in GOG-0199: An NRG Oncology/GOG study

Was Angelina Jolie Right? Optimizing Cancer Prevention Strategies Among BRCA Mutation Carriers

The role of menopausal hormone therapy in women with or at risk of ovarian and breast cancers: Misconceptions and current directions

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