Breast Cancer Research and Treatment

, Volume 124, Issue 3, pp 755–764

BRCA1/2 test results impact risk management attitudes, intentions, and uptake

  • Suzanne C. O’Neill
  • Heiddis B. Valdimarsdottir
  • Tiffani A. DeMarco
  • Beth N. Peshkin
  • Kristi D. Graves
  • Karen Brown
  • Karen E. Hurley
  • Claudine Isaacs
  • Sharon Hecker
  • Marc D. Schwartz
Epidemiology

Abstract

Women who receive positive or uninformative BRCA1/2 test results face a number of decisions about how to manage their cancer risk. The purpose of this study was to prospectively examine the effect of receiving a positive versus uninformative BRCA1/2 genetic test result on the perceived pros and cons of risk-reducing mastectomy (RRM) and risk-reducing oophorectomy (RRO) and breast cancer screening. We further examined how perceived pros and cons of surgery predict intention for and uptake of surgery. 308 women (146 positive, 162 uninformative) were included in RRM and breast cancer screening analyses. 276 women were included in RRO analyses. Participants completed questionnaires at pre-disclosure baseline and 1-, 6-, and 12-months post-disclosure. We used linear multiple regression to assess whether test result contributed to change in pros and cons and logistic regression to predict intentions and surgery uptake. Receipt of a positive BRCA1/2 test result predicted stronger pros for RRM and RRO (P < 0.001), but not perceived cons of RRM and RRO. Pros of surgery predicted RRM and RRO intentions in carriers and RRO intentions in uninformatives. Cons predicted RRM intentions in carriers. Pros and cons predicted carriers’ RRO uptake in the year after testing (P < 0.001). Receipt of BRCA1/2 mutation test results impacts how carriers see the positive aspects of RRO and RRM and their surgical intentions. Both the positive and negative aspects predict uptake of surgery.

Keywords

Breast cancer BRCA mutation Prophylactic mastectomy Prophylactic oophorectomy Screening Pros Cons 

References

  1. 1.
    Chen S, Parmigiani G (2007) Meta-analysis of BRCA1 and BRCA2 penetrance. J Clin Oncol 25:1329–1333CrossRefPubMedGoogle Scholar
  2. 2.
    Breast Cancer Linkage Consortium (1999) Cancer risks in BRCA2 mutation carriers. J Natl Cancer Inst 91:136–1310Google Scholar
  3. 3.
    Metcalfe K, Lynch HT, Ghadirian P et al (2004) Contralateral breast cancer in BRCA1 and BRCA2 mutation carriers. J Clin Oncol 22:2328–2335CrossRefPubMedGoogle Scholar
  4. 4.
    National Comprehensive Cancer Network (2009) NCCN Clinical Practice Guidelines in Oncology. Genetic/Familial High-Risk Assessment: Breast and Ovarian. v.1.2009. http://www.nccn.org/professionals/physician_gls/PDF/genetics_screening.pdf. Accessed 27 Jan 2010
  5. 5.
    Smith KL, Robson ME (2006) Update on hereditary breast cancer. Curr Oncol Rep 8:14–21CrossRefPubMedGoogle Scholar
  6. 6.
    Kauff ND, Satagopan JM, Robson ME et al (2002) Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med 346:1609–1615CrossRefPubMedGoogle Scholar
  7. 7.
    Rebbeck TR, Lynch HT, Neuhausen SL et al (2002) Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med 346:1616–1622CrossRefPubMedGoogle Scholar
  8. 8.
    Vink GR, van Asperen CJ, Devilee P et al (2005) Unclassified variants in disease-causing genes: nonuniformity of genetic testing and counselling, a proposal for guidelines. Eur J Hum Genet 13:525–527CrossRefPubMedGoogle Scholar
  9. 9.
    National Comprehensive Cancer Network (2009) NCCN Clinical Practice Guidelines in Oncology. Genetic/Familial High-Risk Assessment: Breast and Ovarian. v.1.2010. http://www.nccn.org/professionals/physician_gls/PDF/breast-screening.pdf. Accessed 27 Jan 2010
  10. 10.
    Domchek SM, Gaudet MM, Stopfer JE et al (2009) Breast cancer risks in individuals testing negative for a known family mutation in BRCA1 or BRCA2. Breast Cancer Res Treat 119:409–414CrossRefGoogle Scholar
  11. 11.
    Herrinton LJ, Barlow WE, Yu O et al (2005) Efficacy of prophylactic mastectomy in women with unilateral breast cancer: a cancer research network project. J Clin Oncol 23:4275–4286CrossRefPubMedGoogle Scholar
  12. 12.
    McDonnell SK, Schaid DJ, Myers JL et al (2001) Efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. J Clin Oncol 19:3938–3943PubMedGoogle Scholar
  13. 13.
    Peralta EA, Ellenhorn JD, Wagman LD et al (2000) Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing mastectomy for breast cancer. Am J Surg 180:439–445CrossRefPubMedGoogle Scholar
  14. 14.
    Tilanus-Linthorst M, Verhoog L, Obdeijn IM et al (2002) A BRCA1/2 mutation, high breast density and prominent pushing margins of a tumor independently contribute to a frequent false-negative mammography. Int J Cancer 102:91–95CrossRefPubMedGoogle Scholar
  15. 15.
    Rebbeck TR, Kauff ND, Domchek SM (2009) Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers. J Natl Cancer Inst 101:80–97CrossRefPubMedGoogle Scholar
  16. 16.
    Madalinska JB, Hollenstein J, Bleiker E et al (2005) Quality-of-life effects of prophylactic salpingo-oophorectomy versus gynecologic screening among women at increased risk of hereditary ovarian cancer. J Clin Oncol 23:6890–6898CrossRefPubMedGoogle Scholar
  17. 17.
    Parker WH, Jacoby V, Shoupe D et al (2009) Effect of bilateral oophorectomy on women’s long-term health. Womens Health (Lond Engl) 5:565–576Google Scholar
  18. 18.
    Verhoeven MO, van der Mooren MJ, Teerlink T et al (2009) The influence of physiological and surgical menopause on coronary heart disease risk markers. Menopause 16:37–49CrossRefPubMedGoogle Scholar
  19. 19.
    Rini C, O’Neill SC, Valdimarsdottir H et al (2009) Cognitive and emotional factors predicting decisional conflict among high-risk breast cancer survivors who receive uninformative BRCA1/2 results. Health Psychol 28:569–578CrossRefPubMedGoogle Scholar
  20. 20.
    Fang CY, Miller SM, Malick J et al (2003) Psychosocial correlates of intention to undergo prophylactic oophorectomy among women with a family history of ovarian cancer. Prev Med 37:424–431CrossRefPubMedGoogle Scholar
  21. 21.
    Litton JK, Westin SN, Ready K et al (2009) Perception of screening and risk reduction surgeries in patients tested for a BRCA deleterious mutation. Cancer 115:1598–1604CrossRefPubMedGoogle Scholar
  22. 22.
    Warner E, Messersmith H, Causer P et al (2008) Systematic review: using magnetic resonance imaging to screen women at high risk for breast cancer. Ann Intern Med 148:671–679PubMedGoogle Scholar
  23. 23.
    Schwartz MD, Valdimarsdottir HB, DeMarco TA et al (2009) Randomized trial of a decision aid for BRCA1/BRCA2 mutation carriers: impact on measures of decision making and satisfaction. Health Psychol 28:11–19CrossRefPubMedGoogle Scholar
  24. 24.
    Schwartz MD, Peshkin BN, Hughes C et al (2002) Impact of BRCA1/BRCA2 mutation testing on psychologic distress in a clinic-based sample. J Clin Oncol 20:514–520CrossRefPubMedGoogle Scholar
  25. 25.
    Schwartz MD, Peshkin BN, Tercyak KP et al (2005) Decision making and decision support for hereditary breast-ovarian cancer susceptibility. Health Psychol 24:S78–S84CrossRefPubMedGoogle Scholar
  26. 26.
    Meiser B, Butow P, Barratt A et al (1999) Attitudes toward prophylactic oophorectomy and screening utilization in women at increased risk of developing hereditary breast/ovarian cancer. Gynecol Oncol 75:122–129CrossRefPubMedGoogle Scholar
  27. 27.
    Meiser B, Butow P, Friedlander M et al (2000) Intention to undergo prophylactic bilateral mastectomy in women at increased risk of developing hereditary breast cancer. J Clin Oncol 18:2250–2257PubMedGoogle Scholar
  28. 28.
    van Dijk S, Otten W, Zoeteweij MW et al (2003) Genetic counselling and the intention to undergo prophylactic mastectomy: effects of a breast cancer risk assessment. Br J Cancer 88:1675–1681CrossRefPubMedGoogle Scholar
  29. 29.
    Botkin JR, Smith KR, Croyle RT et al (2003) Genetic testing for a BRCA1 mutation: prophylactic surgery and screening behavior in women 2 years post testing. Am J Med Genet A 118A:201–209CrossRefPubMedGoogle Scholar
  30. 30.
    Peshkin BN, Schwartz MD, Isaacs C et al (2002) Utilization of breast cancer screening in a clinically based sample of women after BRCA1/2 testing. Cancer Epidemiol Biomarkers Prev 11:1115–1118PubMedGoogle Scholar
  31. 31.
    Arrington AK, Jarosek SL, Virnig BA et al (2009) Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer. Ann Surg Oncol 16:2697–2704CrossRefPubMedGoogle Scholar
  32. 32.
    Jones NB, Wilson J, Kotur L et al (2009) Contralateral prophylactic mastectomy for unilateral breast cancer: an increasing trend at a single institution. Ann Surg Oncol 16:2691–2696CrossRefPubMedGoogle Scholar
  33. 33.
    McGuire KP, Santillan AA, Kaur P et al (2009) Are mastectomies on the rise? A 13-year trend analysis of the selection of mastectomy versus breast conservation therapy in 5865 patients. Ann Surg Oncol 16:2682–2690CrossRefPubMedGoogle Scholar
  34. 34.
    Sheeran P (2002) Intention-behavior relations: a conceptual and empirical review. Eur Rev Soc Psychol 12:1–36CrossRefGoogle Scholar
  35. 35.
    Fishbein M, Hennessy M, Kamb M et al (2001) Using intervention theory to model factors influencing behavior change. Project RESPECT. Eval Health Prof 24:363–384CrossRefPubMedGoogle Scholar
  36. 36.
    Morgan D, Sylvester H, Lucas FL et al (2009) Cancer prevention and screening practices among women at risk for hereditary breast and ovarian cancer after genetic counseling in the community setting. Fam Cancer 8:277–287CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Suzanne C. O’Neill
    • 1
  • Heiddis B. Valdimarsdottir
    • 2
    • 3
    • 4
  • Tiffani A. DeMarco
    • 1
  • Beth N. Peshkin
    • 1
  • Kristi D. Graves
    • 1
  • Karen Brown
    • 5
  • Karen E. Hurley
    • 6
  • Claudine Isaacs
    • 1
  • Sharon Hecker
    • 1
  • Marc D. Schwartz
    • 1
  1. 1.Cancer Control Program and Fisher Center for Familial Cancer Research, Department of Oncology, Lombardi Comprehensive Cancer CenterGeorgetown UniversityWashingtonUSA
  2. 2.Department of Oncological SciencesMount Sinai School of MedicineNew YorkUSA
  3. 3.Department of Public Health and EducationUniversity of ReykjavikReykjavikIceland
  4. 4.Department of PsychologyUniversity of IcelandReykjavikIceland
  5. 5.Department of Genetics and Genomic SciencesMount Sinai School of MedicineNew YorkUSA
  6. 6.Department of Psychiatry and Behavioral SciencesMemorial Sloan-Kettering Cancer CenterNew YorkUSA

Personalised recommendations