Time to prophylactic surgery in BRCA1/2 carriers depends on psychological and other characteristics

Objective: Bilateral risk-reducing salpingo-oophorectomy (RRSO) has been shown to significantly reduce the risk of ovarian cancer. This study assessed factors predicting uptake of RRSO.Methods/materials: Women participating in a large multiple-case breast cancer family cohort study who were at increased risk for ovarian and fallopian tube cancer (i.e. BRCA1 or BRCA2 mutation carrier or family history including at least one firstor second-degree relative with ovarian or fallopian tube cancer), with no personal history of cancer and with at least one ovary in situ at cohort enrolment, were eligible for this study. Women who knew they did not carry the BRCA1 or BRCA2 mutation segregating in their family (true negatives) were excluded. Sociodemographic, biological and psychosocial factors, including cancer-specific anxiety, perceived ovarian cancer risk, optimism and social support, were assessed using selfadministered questionnaires and interviews at cohort enrolment. RRSO uptake was self-reported every three years during systematic follow-up. Results:Of 2,859 women, 571 were eligible. Mean age was 43.3 years; 62 women (10.9%) had RRSO a median of two years after cohort entry. Factors predicting RRSO were: being parous (OR 3.3, p=0.015); knowing one's mutation positive status (OR 2.9, p<0.001) and having a mother and/or sister who died from ovarian cancer (OR 2.5, p=0.013). Psychological variables measured at cohort entry were not associated with RRSO.Discussion: These results suggest that women at high risk for ovarian cancer make decisions about RRSO based on risk and individual socio-demographic characteristics, rather than in response to psychological factors such as anxiety.

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“…These include being older, e.g. [5,6], number of children e.g. [6], having a family history of ovarian cancer, e.g.…”

Section: Introductionmentioning

confidence: 99%

Psychosocial factors and uptake of risk-reducing salpingo-oophorectomy in women at high risk for ovarian cancer

et al. 2012

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“…Un processus d'information ciblée est en principe mis en place pour adapter cette demande aux indications médicales, aux capacités d'ajustement cognitif des patients et aux possibilités d'intervention. Il est important de noter DÉBAT FORUM notamment sur la perception des risques individuels et familiaux est cependant plus complexe [16]. La perception du risque est un des facteurs sociocognitifs clés de la prédiction des comportements de santé bien qu'il existe une circularité entre perception des risques et pratiques préventives : les personnes ay ant un comportement particulier interprè-tent et réinterprètent leur risque en fonction de ce comportement.…”

Section: Demande De Tests Génétiquesunclassified

“…Ainsi, plus de la moitié des femmes néerlandaises optent pour une mastectomie prophylactique, les femmes américaines et françaises sont plus réticentes et les britanniques ont une position intermédiaire [20,21,[23][24][25][26] . Nous avons montré récemment que les délais de recours à la chirurgie prophylactique étaient très dépendants de l'âge des patientes et de leurs caractéristiques familiales, mais aussi de leurs intentions préalablement à l'annonce du résultat et de l'impact ps ychologique de ces résultats [16]. L'observation de ces comportements confirme les différences selon les pays observées préalablement à la mise en place des tests par le biais d'enquêtes sur les attitudes théoriques de ces populations [27].…”

Section: Modifications Des Comportements De Surveillance Et De Prévenunclassified

Prédisposition génétique aux cancers du sein et de l’ovaire

Julian‐Reynier

2011

Med Sci (Paris)

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Nous détaillerons dans ce texte essentiellement l'importance des tests génétiques BRCA1/2 réalisés chez les femmes. En ce qui concerne les hommes porteurs d'une mutation délétère d'un de ces deux gènes, si leur risque de développer un cancer du sein est élevé par rapport à celui d'un homme non porteur de cette mutation, surtout dans le cas de mutations de BRCA2, le risque absolu qui les concerne reste très faible [3]. Pour les hommes porteurs d'une de ces mutations, l'importance des résultats réside essentiellement dans la nécessité d'informer leur descendance dans la mesure où la mutation est transmise de manière autosomique dominante (donc la probabilité de transmission de cette mutation à leurs enfants est de 50 %). Pour une personne ay ant déjà développé un cancer du sein et/ou de l'ovaire, et dans un contexte le plus souvent d'histoire familiale, la réalisation d'un test génétique (que tous les médecins peuvent prescrire) est considérée comme un élément de diagnostic étiologique, qui donne maintenant aussi des éléments de pronostic et d'aide à la décision chirur gicale et médicale [3,4] . Ainsi, la présence d'une mutation délétère d'un gène BRCA1/2 est indicatrice, pour la personne déjà malade, d'une fréquence plus élevée de récidives ou de la survenue d'autres atteintes. L'absence de découverte de mutation BRCA1/2 chez un cas index quand une mutation familiale n 'était pas connue au préalable, situation de loin la plus fréquente (80 %) lorsque ces analyses sont faites pour la première fois dans de nouvelles familles, est Accès aux tests de prédisposition génétique aux cancers en France L'accès aux tests de prédisposition génétique aux cancers du sein et/ou de l'ovaire (tests d'oncogénétique) se fait en France par le biais de consultations spécia-lisées organisées en réseaux (107 lieux de consultation en 2009). Dans notre pays, ces consultations se sont développées à la fin des années 1990 grâce à des finan-

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“…Details about these cohorts have been published elsewhere. [13][14][15]17 For this study, it was designed specifically for the women who had a breast reconstruction before the PIP recall a cross-sectional telephone survey based on a closed questionnaire which content is presented below was conducted between June and September 2013 in order to collect details about the type of breast reconstruction, the number of surgeries and the procedure involved. Sociodemographic (age, educational level, and marital life) and medical data (clinical stage, treatment) were obtained from the ELIPPSE cohorts questionnaires, whereas the variables relating to breast reconstruction and psychosocial characteristics detailed below were collected in the cross-sectional questionnaire.…”

Section: Data Collectionmentioning

confidence: 99%

“…19 A French translation of this scale had been carried out and validated in previous studies. 17 The women were asked to answer to the questions of their feelings corresponding to the months after they were informed about the PIP problems, i.e. the event was 'the information time about the PIP problems'.…”

mentioning

confidence: 99%

Impact of the Poly Implant Prosthesis Breast Implants Recall in Women With Breast Reconstruction: A South-Eastern French Cross-Sectional Survey Nested in a Prospective Cohort

Julian‐Reynier¹,

Bouhnik²,

Reynier³

et al. 2016

Women Health Open J

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The Poly Implant Prosthesis (PIP) Breast Implants crisis involved thousands of women in the countries concerned, women with breast cancer in particular. It was proposed here to investigate the impact of the PIP Breast Implants recall on women who had undergone Breast Reconstruction at the time of the recall and to analyze the determinants of their Breast Reconstruction decisional outcomes. A cross-sectional telephone survey was performed nested in prospective geographically based cohorts, which consisted of women from the southeastern France with breast cancer. Women were selected who had Breast Reconstructive surgery just before the PIP recall occurred. Dependent variables were the Psychological Impact of the event, Decisional Regret, and Satisfaction with Breast Reconstruction. Determinants of regret and satisfaction were analyzed using simultaneous equations. Among the 148 eligible women, 113(76%) participated. At the initial reconstruction, 90% (n=102) had a Breast Implant, 10% (n=11) had an autologous reconstruction. The PIP recall induced less intrusive thoughts, measured with the Impact of the Event Scale, in the non-PIP groups compared to the PIP one (p=0.025). Regrets about Breast Reconstruction were expressed by 57%; they occurred more frequently when the decision-making was not felt to be sufficiently proactive (adjusted Odds Ratio (ORadj) 5.1; 95% Confidence Interval (CI) (1.2-20.9)) and in those who were dissatisfied with their Breast Reconstruction (ORadj 0.7(95% CI (0.5-0.9))). Satisfaction was significantly lower in women with a Breast Implant, those whose trust in doctors had decreased, in the information-seekers and in less health-literate women. The PIP recall was not found to affect intrusive ideas or denial in women who did not have a PIP Breast Reconstruction. The high frequency of regrets could be reduced by involving women more strongly in the initial decision-making process. Using existing data-bases to assess the impact of new devices on patients' health is an option which organization deserves to be discussed.

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Time to prophylactic surgery in BRCA1/2 carriers depends on psychological and other characteristics

Cited by 35 publications

References 37 publications

Psychosocial factors and uptake of risk-reducing salpingo-oophorectomy in women at high risk for ovarian cancer

Psychosocial factors and uptake of risk-reducing salpingo-oophorectomy in women at high risk for ovarian cancer

Prédisposition génétique aux cancers du sein et de l’ovaire

Impact of the Poly Implant Prosthesis Breast Implants Recall in Women With Breast Reconstruction: A South-Eastern French Cross-Sectional Survey Nested in a Prospective Cohort

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