Uptake Rates of Risk-Reducing Surgeries for Women at Increased Risk of Hereditary Breast and Ovarian Cancer Applied to Cost-Effectiveness Analyses: A Scoping Systematic Review

Galendi, Julia Simões Corrêa; Kautz-Freimuth, Sibylle; Stock, Stephanie; Müller, Dirk

doi:10.3390/cancers14071786

Cited by 9 publications

(9 citation statements)

References 67 publications

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“…Furthermore, a recent value of information analysis showed high decision uncertainty associated with the uptake rates of risk-reducing interventions, suggesting that in the future this uptake rate should be given more attention in the conceptualization of health economic modeling studies [ 101 ].…”

Section: Resultsmentioning

confidence: 99%

“…In general, the literature shows significant variability in risk-reducing surgery uptake among BRCA mutation carriers around the world. These surgeries are widely accepted among women and physicians in Western countries, while they are less accepted in low–middle-income countries, thus reflecting remarkable cultural heterogeneity across countries [ 101 ]. Recent evidence also indicates an improved acceptance trend of preventive surgeries over time, probably due to the progressive improvement in genetic counseling protocols and cross-center knowledge transfer [ 104 ].…”

Section: Resultsmentioning

confidence: 99%

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Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review

Bertozzi

Londero

Xholli

et al. 2023

JCM

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This narrative review aims to clarify the role of breast and gynecological risk-reduction surgery in BRCA mutation carriers. We examine the indications, contraindications, complications, technical aspects, timing, economic impact, ethical issues, and prognostic benefits of the most common prophylactic surgical options from the perspectives of a breast surgeon and a gynecologist. A comprehensive literature review was conducted using the PubMed/Medline, Scopus, and EMBASE databases. The databases were explored from their inceptions to August 2022. Three independent reviewers screened the items and selected those most relevant to this review’s scope. BRCA1/2 mutation carriers are significantly more likely to develop breast, ovarian, and serous endometrial cancer. Because of the Angelina effect, there has been a significant increase in bilateral risk-reducing mastectomy (BRRM) since 2013. BRRM and risk-reducing salpingo-oophorectomy (RRSO) significantly reduce the risk of developing breast and ovarian cancer. RRSO has significant side effects, including an impact on fertility and early menopause (i.e., vasomotor symptoms, cardiovascular disease, osteoporosis, cognitive impairment, and sexual dysfunction). Hormonal therapy can help with these symptoms. Because of the lower risk of developing breast cancer in the residual mammary gland tissue after BRRM, estrogen-only treatments have an advantage over an estrogen/progesterone combined treatment. Risk-reducing hysterectomy allows for estrogen-only treatments and lowers the risk of endometrial cancer. Although prophylactic surgery reduces the cancer risk, it has disadvantages associated with early menopause. A multidisciplinary team must carefully inform the woman who chooses this path of the broad spectrum of implications, from cancer risk reduction to hormonal therapies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review

Bertozzi

Londero

Xholli

et al. 2023

JCM

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“…These data demonstrate huge differences when considering real-world data from the Brazilian population. According to a recent systematic review by ( 42 ), the variability of uptake rates of the risk-reducing surgeries might be explained by several factors, such as (i) cultural differences, (ii) individual-related factors, (iii) age-dependent factors, and (iv) an improved acceptance of preventive surgeries over time. Besides these reasons, it is worth mentioning that economic factors might have also influenced the Brazilian uptake rates identified in our study, for instance, the lack of access to risk-reducing surgeries in the public setting and patients’ expenses with transport, accommodation, and absence from work, once the services that provide these surgeries are usually in cancer reference hospitals or large capitals.…”

Section: Resultsmentioning

confidence: 99%

Cost-Effectiveness of BRCA 1/2 Genetic Test and Preventive Strategies: Using Real-World Data From an Upper-Middle Income Country

et al. 2022

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Although BRCA1/2 genetic testing in developed countries is part of the reality for high-risk patients for hereditary breast and ovarian cancer (HBOC), the same is not true for upper-middle-income countries. For that reason, this study aimed to evaluate whether the BRCA1/2 genetic test and preventive strategies for women at high risk for HBOC are cost-effective compared to not performing these strategies in an upper-middle-income country. Adopting a payer perspective, a Markov model with a time horizon of 70 years was built to delineate the health states for a cohort of healthy women aged 30 years that fulfilled the BRCA1/2 testing criteria according to the guidelines. Transition probabilities were calculated based on real-world data of women tested for BRCA1/2 germline mutations in a cancer reference hospital from 2011 to 2020. We analyzed 275 BRCA mutated index cases and 356 BRCA mutation carriers that were first- or second-degree relatives of the patients. Costs were based on the Brazilian public health system reimbursement values. Health state utilities were retrieved from literature. The BRCA1/2 genetic test and preventive strategies result in more quality-adjusted life years (QALYs) and costs with an incremental cost-effectiveness ratio of R$ 11,900.31 (U$ 5,504.31)/QALY. This result can represent a strong argument in favor of implementing genetic testing strategies for high-risk women even in countries with upper-middle income, considering not only the cancer prevention possibilities associated with the genetic testing but also its cost-effectiveness to the health system. These strategies are cost-effective, considering a willingness-to-pay threshold of R$ 25,000 (U$ 11,563.37)/QALY, indicating that the government should consider offering them for women at high risk for HBOC. The results were robust in deterministic and probabilistic sensitivity analyses.

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“…In the absence of reliable figures on the uptake of RRM by BRCA1/2 PV carriers in Germany, it is not viable to put the RRM rate found in our study sample into national context. Internationally, uptake rates between 6% and 47% have been reported, with reported rates varying not only between, but also within countries 36 . These uptake rates may be influenced by a variety of factors, such as the national health care system, regionally based health care providers, or cultural differences.…”

Section: Discussionmentioning

confidence: 99%

“…Internationally, uptake rates between 6% and 47% have been reported, with reported rates varying not only between, but also within countries. 36 These uptake rates may be influenced by a variety of factors, such as the national health care system, regionally based health care providers, or cultural differences. However, in order to obtain a comprehensive picture about RRM uptake, individual, interpersonal, cultural and systemic factors must be taken into account to shed light on the decision-making process.…”

Section: Discussionmentioning

confidence: 99%

Psychological distress and decision‐making factors for prophylactic bilateral mastectomy in cancer‐unaffected BRCA1/2 pathogenic variant carriers

et al. 2023

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Objective Women carrying a BRCA1/2 pathogenic variant have an increased risk for breast cancer and may opt for risk‐reducing bilateral mastectomy. In this study, we examine which demographic, psychosocial, and personality factors are associated with their decision to undergo risk‐reducing bilateral mastectomy. Methods Cancer‐unaffected women with a pathogenic variant in BRCA1 or BRCA2 were recruited before receiving their genetic test result and completed follow‐up including decision to undergo mastectomy over 6–8 months after genetic test result disclosure. Anxiety, depression, breast cancer worry, personality and sociodemographic data were assessed. Results A total of 125 cancer‐unaffected women were included in the analysis. Participants were found to have higher anxiety levels than the general female population regardless of mastectomy decision. Breast cancer worry was higher among women who opted for risk‐reducing mastectomy and did not decrease over time. By contrast, women who did not opt for surgery experienced decreasing levels of breast cancer worry. Regression analysis found that women with a pathogenic variant in BRCA1, younger women and women with higher breast cancer worry were more likely to opt for surgery. Conclusions Our study provides valuable insights into the factors that influence women with a BRCA1/2 pathogenic variant to undergo risk‐reducing mastectomy. These findings may be helpful in understanding individual differences in decision‐making concerning preventive options and show the need to address negative anticipatory feelings associated with carrying a pathogenic variant in a high breast cancer risk gene in clinical care.

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Uptake Rates of Risk-Reducing Surgeries for Women at Increased Risk of Hereditary Breast and Ovarian Cancer Applied to Cost-Effectiveness Analyses: A Scoping Systematic Review

Cited by 9 publications

References 67 publications

Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review

Risk-Reducing Breast and Gynecological Surgery for BRCA Mutation Carriers: A Narrative Review

Cost-Effectiveness of BRCA 1/2 Genetic Test and Preventive Strategies: Using Real-World Data From an Upper-Middle Income Country

Psychological distress and decision‐making factors for prophylactic bilateral mastectomy in cancer‐unaffected BRCA1/2 pathogenic variant carriers

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