Uptake of Risk-Reducing Surgery in Unaffected Women at High Risk of Breast and Ovarian Cancer Is Risk, Age, and Time Dependent

Evans, D. Gareth; Lalloo, Fiona; Ashcroft, Linda; Shenton, Andrew; Clancy, Tara; Baildam, A.D.; Brain, A.; Hopwood, Penelope; Howell, Anthony

doi:10.1158/1055-9965.epi-09-0171

Cited by 133 publications

(132 citation statements)

References 41 publications

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“…Our findings demonstrate that women with offspring are more likely to opt for RRSO; this result is consistent with other studies, which found that not having children was associated with delaying surgery [9,28]. The observed association between having offspring and uptake of RRSO is of course not surprising, given that RRSO results in irreversible infertility, and is therefore unlikely to be attractive to women who have not yet had children or those who are parous but are uncertain about whether to have more children.…”

Section: Discussionsupporting

confidence: 93%

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

et al. 2012

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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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Section: Discussionsupporting

confidence: 93%

“…[8], and being a carrier of a BRCA1 or BRCA2 mutation, e.g. [7,9]. However, almost no empirical evidence is available on the psychological determinants of the decision to undertake RRSO.…”

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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“…[19][20][21][22] Choosing RRBSO appears to be related to older age, perceived cancer risk, and perceived benefit of surgery. [99][100][101][104][105][106] In a 2012 long-term outcome study, Schwartz et al observed that >80% of BRCA1/BRCA2 carriers had undergone RRM, or RRBSO, or both at approximately 5 years after testing. Carriers also were more likely to have received breast cancer chemoprevention and breast magnetic resonance imaging screening.…”

Section: Hbocmentioning

confidence: 99%

Psychiatric implications of cancer genetic testing

Hirschberg

Chan‐Smutko

Pirl

2014

Cancer

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As genetic testing for hereditary cancer syndromes has transitioned from research to clinical settings, research regarding its accompanying psychosocial effects has grown. Men and women being tested for hereditary cancer syndromes may experience some psychological distress while going through the process of testing or after carrier status is identified. Psychological distress appears to decrease over the course of the first year and it is typically not clinically significant. Longer term studies show mixed results with some mutation carriers continuing to experience elevated distress. Baseline distress is the greatest risk factor for both immediate (weeks-12 months) and long-term psychological distress (18 mo-8 years post genetic testing). In addition to baseline psychological distress, other risk factors can be identified to help identify individuals who may need psychosocial interventions during the genetic testing process. The challenges of providing clinical care to the growing population of individuals identified to be at increased risk for heritable cancers present opportunities for research and new models of care. Cancer 2015;121:341-60. V C 2014 American Cancer Society.KEYWORDS: BRCA1, BRCA2, HNPCC, Lynch syndrome, genetic testing, unaffected carrier, carrier, hereditary cancer syndrome, riskreducing surgeries, psychosocial. INTRODUCTIONSeveral familial cancer syndromes that confer a high lifetime risk of cancer can be identified with genetic testing, and greater numbers of men and women will consider testing as the availability and public awareness of genetic testing for cancer susceptibility continue to increase. Research to date suggests that these individuals will have varied emotional responses to the process of genetic testing as well as its results.When genetic testing for cancer syndromes first transitioned from research protocols to clinics, there was initial concern that it would be similar to genetic testing for Huntington disease. Many worried that knowing they are at high risk for cancer in the future may be too distressing for some individuals, possibly even leading to suicide. However, several systematic reviews focusing primarily on hereditary breast and ovarian cancer (HBOC) and Lynch syndrome, also known as hereditary nonpolyposis colon cancer (HNPCC), have demonstrated that most individuals who have a mutation identified in an associated gene cope well with the knowledge of their genetic status. 1-3 Data regarding psychological implications of the genetic testing process are the most robust for women who present for HBOC risk assessment, which involves discussion of the BRCA1 and BRCA2 genes, although there are increasing studies for HNPCC, familial adenomatous polyposis (FAP), and other hereditary cancer syndromes.Although the rates of distress in individuals undergoing genetic testing vary, they appear to be relatively small. Studies have demonstrated that approximately 6% to 24% of individuals undergoing genetic testing for a BRCA1/BRCA2-associated or HNPCC-associated mutations repo...

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“…the disadvantage of rrSo is a premature menopause and iatrogenic fertility, and therefore, it is recommended not to be performed earlier than the age of close to 40 years (4). young mutation carriers benefit most from riskreducing surgery (19). In older age groups, the breasts are generally easier to follow up, and the patients are less likely to choose surgical risk-reduction (20).…”

Section: Reconstruction N=27mentioning

confidence: 99%

The frequency and outcome of breast cancer risk-reducing surgery in finnish BRCA1 and BRCA2 mutation carriers

et al. 2013

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IntroductIon the cumulative lifetime risk of having breast cancer is 65% (44%−78%) in BRCA1 gene mutation carriers and 45% (31%−56%) in BRCA2 carriers. For ovarian cancer, the risks are 39% (18%−54%) and 11% (2.4%−19%) for BRCA1 and BRCA2 carriers, respectively (1). risk management strategies in women with BRCA1 or BRCA2 mutation include cancer screening, chemoprevention, or risk-reducing surgery (2). cancer screening by different modalities aims at early detection of breast cancer, when it still is curable by appropriate treatment. Present recommendations for surveillance include annual breast magnetic resonance imaging (MrI), mammography, and ultrasound in addition to clinical breast examination and breast self-examination. the combination of MrI, mammography, and ultrasound has a sensitivity of 95% versus 45% for mammography as the only modality (3). THE FREQUENCY AND OUTCOME OF BREAST CANCER RISK-REDUCING SURGERY IN FINNISH

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Uptake of Risk-Reducing Surgery in Unaffected Women at High Risk of Breast and Ovarian Cancer Is Risk, Age, and Time Dependent

Cited by 133 publications

References 41 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

Psychiatric implications of cancer genetic testing

The frequency and outcome of breast cancer risk-reducing surgery in finnish BRCA1 and BRCA2 mutation carriers

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