Uptake, time course, and predictors of risk-reducing surgeries in BRCA carriers

Abstract

Introduction and aims: For women who carry BRCA mutations, risk-reducing surgeries are an option to decrease breast and ovarian cancer risk. This study aims to determine the uptake, time course, and predictors of risk-reducing mastectomy (RRM) and risk-reducing salpingo-oophorectomy (RRSO) in BRCA carriers.

Results: In 272 female carriers, followed for a median of 3.7 years, 23% of those eligible chose RRM, and 51% percent chose RRSO. Among BRCA carriers who chose these procedures, median time to both RRM and RRSO was approximately 4 months after learning of BRCA-positive results. Predictors of RRM were as follows: age below 60 years (hazard ratio 1.8, p=0.04), prior breast cancer (hazard ratio 2.4, p=0.0004), and RRSO (hazard ratio 7.2, p<0.0001). Predictors of RRSO were as follows: age below 60 years (hazard ratio 3.6, p=0.006), prior breast cancer (hazard ratio 1.8, p=0.002), and RRM (hazard ratio 5.4, p<0.0001).

Conclusions: Many women who undergo BRCA testing use these results to make clinical decisions; those who choose risk-reducing surgeries typically do so within months of receiving BRCA-positive results. Predictors of risk-reducing surgery uptake include the following: age below 60 years, prior breast cancer, and utilization of another risk-reducing surgery. Future research directions include examining other preventive and screening options in BRCA carriers as well as studying motivations for choosing or declining risk-reducing surgeries.

FIG. 1.

Uptake of risk-reducing mastectomy (RRM), stratified by age at BRCA testing (Kaplan–Meier). The x-axis represents the proportion of study subjects who uptake RRM. The y-axis represents time since BRCA-positive results disclosure. The four Kaplan–Meier curves in this figure represent RRM uptake in subjects of the following ages at BRCA testing: below 40, between 40 and 49, between 50 and 59, and 60 and above.

FIG. 2.

Uptake of risk-reducing salpingo-oophorectomy (RRSO), stratified by age at BRCA testing (Kaplan–Meier). The x-axis represents the proportion of study subjects who uptake RRSO. The y-axis represents time since BRCA-positive results disclosure. The four Kaplan–Meier curves in this figure represent RRSO uptake in subjects of the following ages at BRCA testing: below 40, between 40 and 49, between 50 and 59, and 60 and above.

FIG. 3.

Uptake of risk-reducing mastectomy (RRM), stratified by prior history of breast cancer (Kaplan–Meier). The x-axis represents the proportion of study subjects who uptake RRM. The y-axis represents time since BRCA-positive results disclosure. The two Kaplan–Meier curves in this figure represent RRM uptake in study subjects with and without a prior history of breast cancer.

FIG. 4.

Uptake of risk-reducing salpingo-oophorectomy (RRSO), stratified by prior history of breast cancer (Kaplan–Meier). The x-axis represents the proportion of study subjects who uptake RRSO. The y-axis represents time since BRCA-positive results disclosure. The two Kaplan–Meier curves represent RRSO uptake in study subjects with and without a prior history of breast cancer.