scholarly journals Factors Impacting on Decision-Making towards Prophylactic Surgeries in BRCA Mutation Carriers and Women with Familial Predisposition

Breast Care ◽  
2019 ◽  
Vol 15 (3) ◽  
pp. 253-259
Author(s):  
Robin Segerer ◽  
Clara Peschel ◽  
Ulrike Kämmerer ◽  
Sebastian Häussler ◽  
Achim Wöckel ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Decision Making ◽  
Brca Mutation ◽  
Prophylactic Surgery ◽  
Sexual Life ◽  
Familial Predisposition ◽  
Emotional Factors ◽  
Mutation Carriers ◽  
Brca Mutation Carriers ◽  
Psychological Predictor

Background/Objectives: BRCA mutation carriers and women at high risk of breast/ovarian cancer are faced with the intricate question to opt for prophylactic surgeries and/or a periodic screening. The aim of this study was therefore to identify objective and emotional factors that have an impact on the decision-making process. Methods: Ninety-five women with BRCA mutations or women at increased breast/ovarian cancer lifetime risk were counseled at our outpatient department and either opted for prophylactic surgery or periodic screening. To identify the psychological factors that could have influenced the decision-making, a standardized questionnaire was applied. Additionally, clinical data were collected and were reviewed by a personal talk. Results: Seventy-one of the patients opted for an increased surveillance only, 21 for prophylactic surgeries. Positive predictors for prophylactic surgeries were sociodemographic characteristics such as parity and objective variables such as verified mutation status. Hierarchical regression analysis revealed that the need for safety in health issues has been the only significant psychological predictor of surgery beyond the objective factors. Fear of surgical procedures, menopausal symptoms after surgery, loss of attractiveness, or fear of interferences with sexual life did not significantly affect decision-making. Conclusion: Decision-making towards prophylactic surgeries is influenced by objective but also emotional factors. Knowing that fear and anxiety also have an important impact on decision-making, distinct counselling about the procedures, the subsequent risk reduction as well as the psychological effects of prophylactic surgeries are essential.

Sexual function, anxiety, and surgical decision making in BRCA mutation carriers.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21572-e21572
Author(s):  
Matthew T. Oliver ◽  
Rebecca Kwait ◽  
Jessica Kent Laprise ◽  
Jennifer Scalia Wilbur ◽  
Sarah Spinette ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Decision Making ◽  
Brca Mutation ◽  
Hormone Replacement ◽  
Prophylactic Surgery ◽  
Surgical Decision ◽  
Mutation Carriers ◽  
Brca Mutation Carriers ◽  
Surgical Decision Making

e21572 Background: To describe BRCA mutation carriers’ perspectives on quality of life from prophylactic surgical decision making. Methods: A cross-sectional survey of BRCA mutation carriers identified from a genetic counseling database at an academic women’s oncology program was conducted using Research Electronic Data Capture. Survey items included Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale, and investigator-generated questions. Statistical analysis was performed using Fisher’s exact test and Wilcoxon rank-sum or Kruskal-Wallis tests. Results: 66 BRCA mutation carriers completed the survey (39% response rate) with a median age of 50 (range 18 to 79); 23% of respondents were pre- or perimenopausal and 11% reported a history of ovarian/fallopian tube cancer. Overall, 25% of respondents reported anxiety regarding the timing of bilateral salpingo-oophorectomy (BSO) or mastectomy. Women who had a BSO were less likely to be sexually active and had lower total FSFI scores, with arousal and desire approaching significance compared to women without BSO (p = 0.05). Women who had a BSO had slightly higher median total anxiety scores, but were not more likely to have abnormal levels of anxiety. Women who were < 40 years of age at discovery of mutation were more likely to have had a discussion regarding preimplantation genetic diagnosis (p < 0.0001), more likely to have anxiety regarding prophylactic surgery and childbearing (p < 0.0001), and more likely to say BRCA mutation impacted their decisions about childbearing (p = 0.001) compared to women > 40. 57% of women age 18-39 at time of mutation diagnosis delayed BSO for childbearing as compared to none of the women > 40 (p < 0.0001). Only 20% of the pre- or perimenopausal women used hormone replacement therapy after BSO. Conclusions: BRCA mutation carriers face challenging decisions concerning prophylactic surgical management. Counseling sessions often focus on effective risk reducing surgeries but may not directly address other emotional and physical consequences of prophylactic surgery. Counseling regarding use of hormone replacement therapy is an area identified in this study that may improve quality of life issues seen in women undergoing prophylactic BSO.

scholarly journals Recommendations and Choices for BRCA Mutation Carriers at Risk for Ovarian Cancer: A Complicated Decision

Cancers ◽  
2018 ◽  
Vol 10 (2) ◽  
pp. 57 ◽  
Author(s):  
Kelsey Lewis ◽  
Karen Lu ◽  
Amber Klimczak ◽  
Samuel Mok
Keyword(s):  
Ovarian Cancer ◽  
At Risk ◽  
Brca Mutation ◽  
Mutation Carriers ◽  
Brca Mutation Carriers

scholarly journals Cost Effectiveness of Risk-Reducing Mastectomy versus Surveillance in BRCA Mutation Carriers with a History of Ovarian Cancer

2017 ◽  
Vol 24 (11) ◽  
pp. 3116-3123 ◽  
Author(s):  
Charlotte Gamble ◽  
Laura J. Havrilesky ◽  
Evan R. Myers ◽  
Junzo P. Chino ◽  
Scott Hollenbeck ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cost Effectiveness ◽  
Brca Mutation ◽  
Mutation Carriers ◽  
Brca Mutation Carriers ◽  
History Of ◽  
Risk Reducing

Breast Cancer Following Ovarian Cancer in BRCA Mutation Carriers

2020 ◽  
Vol 156 (3) ◽  
pp. e14-e15
Author(s):  
A.I. Nañez ◽  
S. Langer ◽  
C. Garcia ◽  
C.B. Powell
Keyword(s):  
Breast Cancer ◽  
Ovarian Cancer ◽  
Brca Mutation ◽  
Mutation Carriers ◽  
Brca Mutation Carriers

Risk-reducing salpingo-oophorectomy and prophylactic mastectomy among BRCA mutation “previvors.”

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 1518-1518
Author(s):  
Laura L. Holman ◽  
Molly S Daniels ◽  
Amanda C. Brandt ◽  
Banu Arun ◽  
Elizabeth Keeler ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Screening ◽  
High Risk ◽  
Prophylactic Mastectomy ◽  
Brca Mutation ◽  
Premenopausal Women ◽  
Prophylactic Surgery ◽  
Ovarian Cancer Screening ◽  
Brca Mutation Carriers ◽  
Risk Reducing

1518 Background: We prospectively evaluated the timing and uptake of risk-reducing surgery in a cohort of female BRCA mutation carriers that have no personal cancer history (“previvors”). Methods: Patients at high risk of breast and ovarian cancer were enrolled between 2007 and 2011 and followed in a high-risk ovarian cancer screening clinic. Women were offered risk-reducing salpingo-oophorectomy (RRSO) and/or prophylactic mastectomy (PM) per guidelines. Their clinical data were recorded and analyzed using descriptive statistics. Results: Of 260 BRCA mutation carriers enrolled, 73 have no personal history of cancer and are “previvors.” Patients have been followed for a median of 26.5 months (1-50 months). The median age is 38 years, 81.1% are white, 16.2% are Ashkenazi Jewish, and 79.7% are premenopausal. BRCA1 carriers account for 43.2% of participants and 55.4% have a BRCA2 mutation. The majority of patients (77.6%) presented for ovarian cancer screening <1 year after their BRCA testing. In all, 60.8% of women underwent prophylactic surgery: 28.4% chose RRSO, 18.9% chose PM, and 13.5% chose both procedures. Postmenopausal women were more likely to choose RRSO, while uptake for both procedures was common for premenopausal women (Table, p=0.04). RRSO was also more likely in parous than nulliparous premenopausal women (35.2% vs 9% p=0.001). PM was not associated with parity (p=0.79). Of women that had both surgeries, 20% had them concurrently and 20% had PM first. Of the 60% that underwent RRSO first, all had their second surgery within 14 months. Conclusions: BRCA mutation “previvors” have a high overall uptake of prophylactic surgery. Premenopausal women are more likely to choose PM than postmenopausal women; reasons for this are unclear. “Previvors” that choose RRSO and PM typically have both surgeries within a fairly short timeframe. With the growing population of “previvors” in the US, further study of patient preferences regarding preventative surgery and long-term consequences is needed. [Table: see text]

Comparison of risk-reducing surgery in women with BRCA and non-BRCA ovarian cancer susceptibility genes.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1547-1547
Author(s):  
Zachary Phillip Schwartz ◽  
Mae Zakhour ◽  
Andrew John Li ◽  
Christine S. Walsh ◽  
Bj Rimel ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Susceptibility ◽  
Brca Mutation ◽  
Susceptibility Genes ◽  
Brca Mutations ◽  
Cancer Susceptibility Genes ◽  
Mutation Carriers ◽  
Brca Mutation Carriers ◽  
History Of ◽  
Risk Reducing

1547 Background: Risk reducing gynecologic surgery (RRSO) is standard of care for women with BRCA mutations. The optimal management for women with non-BRCA ovarian cancer susceptibility mutations remains unclear. We sought to characterize the practice patterns for these women at our two institutions. Methods: Women with germline ovarian cancer susceptibility genes who had a RRSO were identified from 1/2000-1/2019 in an IRB approved study. All patients were asymptomatic with no suspicion for malignancy at time of RRSO. Clinico-pathologic characteristics were extracted from the medical records. Continuous variables were analyzed with Kruskal-Wallis and categorical variables analyzed with chi square and t-tests. Results: 152 BRCA1, 95 BRCA2, and 63 Non-BRCA mutation carriers were identified—50 Lynch (22 MLH1, 13 MSH2, 13 MSH6, 2 PMS2) and 13 Other (6 BRIP1, 2 RAD51C, 5 RAD51D). There was no difference between age at testing, age at RRSO, and interval between testing and RRSO between groups. Genetic counseling was higher in Non-BRCA patients. Family history of ovarian cancer was more common in women with BRCA1 and Other germline mutations compared to BRCA2 and Lynch. Family and personal history of breast cancer was high in all groups except Lynch carriers. Prophylactic mastectomy was seen mostly in BRCA mutation carriers. Concomitant hysterectomy was performed in the majority of women (BRCA1 59%, BRCA2 57%, and Other 62%), with the highest frequency in Lynch carriers (86%, p<.01). Occult cancer was only seen in BRCA mutation carriers: BRCA1 (7%), BRCA2 (2%), Lynch (0%), Other (0%). Conclusions: In this cohort, women with Non-BRCA mutations are managed similarly to women with BRCA mutations. We observed no occult cancers in Non-BRCA patients. The optimal role of surgery as a risk reducing strategy in this group requires further study. [Table: see text]

Population attributes affecting the prevalence of BRCA mutation carriers in epithelial ovarian cancer cases in israel

2003 ◽  
Vol 89 (3) ◽  
pp. 494-498 ◽  
Author(s):  
G Hirsh-Yechezkel ◽  
A Chetrit ◽  
F Lubin ◽  
E Friedman ◽  
T Peretz ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Brca Mutation ◽  
Mutation Carriers ◽  
Brca Mutation Carriers
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