Menopausal hormone therapy for BRCA-mutation carriers: attitudes of Israeli healthcare providers before and after a brief educational intervention

Abstract

Objective: BRCA-mutation carriers are offered risk-reducing bilateral salpingo-oophorectomy (RRBSO) at age 35 to 40 years, leading to major life-quality and health-related issues associated with early menopause. Hormone therapy (HT) may significantly alleviate menopausal symptoms without increasing breast or ovarian cancer risk in BRCA carriers. We investigated attitudes of Israeli healthcare providers to HT post-RRBSO in BRCA carriers, before and after a brief educational intervention. Methods: In this pre-post survey of gynecologic departments in Israel, healthcare providers were given questionnaires (based on scores of 1-4) assessing attitudes to prescribing HT in different clinical scenarios, before and after an educational intervention on current knowledge about HT in BRCA-mutation carriers. Higher scores indicated higher tendency to prescribe HT. Mean and median scores were calculated for each scenario, and the association between scores and various healthcare providers’ characteristics were assessed. The change in attitude pre versus postintervention was evaluated, and the Cohen's d effect size was calculated. Results: Of the 200 healthcare providers who were offered participation, 162 responded. Of them, 25.3% were obstetricians, 13.6% gynecologists, 5.55% gynecologic-oncologists, 8% medical oncologists, 38.9% obstetrics-gynecology residents, and 8.6% were nurses. Median age was 44 (interquartile range 36-58); 42.6% were males. Higher score correlated weakly with older age, but did not correlate with gender or personal HT/menopause experience. Significantly higher mean and median preintervention scores were obtained by gynecologists (3.2±0.96; 4 [2.25-4]) and gynecologic-oncologists (3.6 ± 0.78; 4 [3.6-4.0]) than by medical oncologists (2.6 ± 1.06; 2.13 [1.88-3.81]), obstetricians (2.7 ± 1.09; 2.25 [1.88-4.0]), residents (2.48 ± 0.99; 2 [1.69-3.56]) or nurses (2.2 ± 0.92; 2 [1.5-2.69]). Overall scores were higher postintervention (P < 0.001, effect size d = 0.901). The change in scores postintervention was most prominent among younger participants and nurses. Conclusions: In Israel, it is acceptable to offer HT post-RRBSO to healthy BRCA-mutation carriers. Younger healthcare workers and nurses tend to be more hesitant, yet they are more likely to adopt a pro-HT attitude after an educational intervention. Such intervention is likely to improve overall care for BRCA-mutation carriers.

Risk‐reducing salpingo‐oophorectomy and breast cancer incidence among Jewish BRCA1/BRCA2‐mutation carriers—an Israeli matched‐pair study

“…21 Both physicians and BRCA PSV carriers are sometimes reluctant to either offer or use HRT after RRBSO, primarily because of the existing perception of increased breast cancer risk. 22,23 However, the association between HRT use after RRBSO and breast cancer risk was previously studied 24 and no apparent increased risk was noted, though data are scarcer for BRCA2 PSV carriers. 25 The current study results, demonstrating that HRT rate was higher in the cer precludes proper analysis of this factor.…”

“…The use of HRT may significantly alleviate menopausal symptoms and reduce health risks including loss of bone density with osteopenia and osteoporosis, impaired cardiovascular health, and a possible cognitive function decrease 21 . Both physicians and BRCA PSV carriers are sometimes reluctant to either offer or use HRT after RRBSO, primarily because of the existing perception of increased breast cancer risk 22,23 . However, the association between HRT use after RRBSO and breast cancer risk was previously studied 24 and no apparent increased risk was noted, though data are scarcer for BRCA2 PSV carriers 25 .…”