Prophylactic Surgery Decisions and Surveillance Practices One Year Following BRCA1/2 Testing

Reviewers: Li Liu, MD
Source: Preventive Medicine, Volume 31:75-80, (August) 2000

Précis: BRCA testing has low impact on screening compliance

Introduction

Germline BRCA1/2 mutations are associated with greatly increased risk of developing breast and ovarian cancers. Genetic testing has made it possible for some women to determine whether or not they escaped or inherited this mutation. One of the treatment options for women who carry BRCA1/2 mutations is prophylactic mastectomy and/or oophorectomy. This study evaluated screening compliance among identified mutation carriers.

Method

The investigators monitored 304 women in hereditary breast-ovarian cancer families who were offered BRCA1/2 testing. Of these women, 49 declined testing, 84 tested positive, 83 tested negative and the rest were lost to follow-up after 1 year. The investigators assessed prophylactic surgery and surveillance behavior one year following BRCA1/2 testing.

Results

• One month after testing, 36% of carriers reported they were considering prophylactic mastectomy and 45% said they were considering prophylactic oophorectomy.
• BRCA1/2 mutation carriers were significantly more likely than noncarriers to adopt the recommended mammography guidelines (68% vs. 44%).
• 32% of carriers were not adherent at 1-year to mammographic follow-up guidelines and carriers? rates of mammography adherence were not significantly different from baseline.

Discussion

In this study, most women who were carriers of BRCA1 and BRCA2 mutations did not consider prophylactic mastectomy or oophorectomy to reduce their risk of breast and ovarian cancers, at least in the short term. Carriers also did not appear to improve their adherence to screening recommendations after learning their carrier status. Patient education and risk communication between patients and health care providers may help patients with their decision-making.