Perception of screening and risk reduction surgeries in patients tested for a BRCA deleterious mutation

Abstract

BACKGROUND: Women at a high risk for breast cancer are offered choices for screening or prophylactic surgeries. The aim of this study was to evaluate opinions regarding screening and surgical strategies in high‐risk women. METHODS: Women at the authors' institution who received BRCA1 of 2 testing before July 2005 were sent a follow‐up patient survey. The authors compared responses of women who tested positive for a deleterious mutation with those who tested negative. For those who expressed an opinion (agree vs disagree), a 2‐sided Fisher exact test was used to compare responses. RESULTS: A total of 540 surveys were sent, and 312 were returned (58%). Of these, 217 had breast cancer, and 86 women tested positive for a mutation. No BRCA+ women felt mammograms were difficult to get because of discomfort, whereas 5.4% of the BRCA− group did (P = .039). Seventy percent of BRCA+ women agreed that prophylactic mastectomy (PM) is the most effective means for reducing risk, compared with 40% of BRCA− women (P < .001). PM was felt to be the only way to reduce worry in 64.7% of BRCA+ and in 34.4% of BRCA− women (P < .001). PM was felt to be too drastic for 36.1% of BRCA+ and 40.5% of BRCA− women (P = .562). Difficulty in deciding between screening and PM occurred in 23.9% of BRCA+ and 12.5% of BRCA− women (P = .046). After excluding women with bilateral breast cancers, 81.0% of women who agreed that PM was best to reduce risk underwent a PM versus 19.1% of those who disagreed (P < .001). Of women who felt PM was the only way to reduce worry, 84.2% underwent PM. Only 15.8% of women who did not believe that it was the only way to decrease worry underwent PM (P < .001). CONCLUSIONS: BRCA mutation carriers were more likely to believe PM to be the best way to reduce both risk and worry of breast cancer. High‐risk women who agreed that PM was more likely to reduce risk and worry of breast cancer were more likely to proceed with this intervention. Cancer 2009. © 2009 American Cancer Society.