International trends in the uptake of cancer risk reduction strategies in women with a BRCA1 or BRCA2 mutation

Kelly Metcalfe^{1

2}, Andrea Eisen³, Leigha Senter⁴, Susan Armel⁵, Louise Bordeleau⁶, Wendy S Meschino⁷, Tuya Pal⁸, Henry T Lynch⁹, Nadine M Tung¹⁰, Ava Kwong^{11

12

13}, Peter Ainsworth¹⁴, Beth Karlan¹⁵, Pal Moller^{16

17

18}, Charis Eng¹⁹, Jeffrey N Weitzel²⁰, Ping Sun¹, Jan Lubinski²¹, Steven A Narod^{22

23}; Hereditary Breast Cancer Clinical Study Group

Affiliations

¹ Women's College Research Institute, Toronto, ON, Canada.
² Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
³ Toronto-Sunnybrook Regional Cancer Center, Toronto, ON, Canada.
⁴ Division of Human Genetics, The Ohio State University Medical Center, Comprehensive Cancer Center, Columbus, OH, USA.
⁵ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.
⁶ Juravinksi Cancer Centre, Hamilton, ON, L8V 5C2, Canada.
⁷ North York General Hospital, Toronto, ON, Canada.
⁸ Vanderbilt-Ingram Cancer Center/Vanderbilt University Medical Center, Nashville, TN, USA.
⁹ Hereditary Cancer Center, Creighton University School of Medicine, Omaha, NE, USA.
¹⁰ Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹¹ Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR.
¹² Department of Surgery, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR.
¹³ Hong Kong Hereditary Breast Cancer Family Registry, Happy Valley, Hong Kong SAR.
¹⁴ Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA.
¹⁵ Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, West Hollywood, CA, USA.
¹⁶ Research Group Inherited Cancer, Department of Medical, Genetics, Oslo University Hospital, Oslo, Norway.
¹⁷ Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, part of Oslo University Hospital, Oslo, Norway.
¹⁸ Center for Hereditary Tumors, HELIOS-Klinikum Wuppertal, University of Witten-Herdecke, Wuppertal, Germany.
¹⁹ Genomic Medicine Institute, Center for Personalised Genetic Healthcare, Cleveland Clinic, Cleveland, OH, USA.
²⁰ City of Hope National Medical Center, Duarte, CA, USA.
²¹ International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland.
²² Women's College Research Institute, Toronto, ON, Canada. steven.narod@wchospital.ca.
²³ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. steven.narod@wchospital.ca.

PMID: 30971774
PMCID: PMC6738089
DOI: 10.1038/s41416-019-0446-1

International trends in the uptake of cancer risk reduction strategies in women with a BRCA1 or BRCA2 mutation

Kelly Metcalfe et al. Br J Cancer. 2019 Jul.

. 2019 Jul;121(1):15-21.

doi: 10.1038/s41416-019-0446-1. Epub 2019 Apr 11.

Authors

Affiliations

¹ Women's College Research Institute, Toronto, ON, Canada.
² Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
³ Toronto-Sunnybrook Regional Cancer Center, Toronto, ON, Canada.
⁴ Division of Human Genetics, The Ohio State University Medical Center, Comprehensive Cancer Center, Columbus, OH, USA.
⁵ Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada.
⁶ Juravinksi Cancer Centre, Hamilton, ON, L8V 5C2, Canada.
⁷ North York General Hospital, Toronto, ON, Canada.
⁸ Vanderbilt-Ingram Cancer Center/Vanderbilt University Medical Center, Nashville, TN, USA.
⁹ Hereditary Cancer Center, Creighton University School of Medicine, Omaha, NE, USA.
¹⁰ Beth Israel Deaconess Medical Center, Boston, MA, USA.
¹¹ Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong SAR.
¹² Department of Surgery, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong SAR.
¹³ Hong Kong Hereditary Breast Cancer Family Registry, Happy Valley, Hong Kong SAR.
¹⁴ Department of Population Sciences, Beckman Research Institute of City of Hope, Duarte, CA, USA.
¹⁵ Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, West Hollywood, CA, USA.
¹⁶ Research Group Inherited Cancer, Department of Medical, Genetics, Oslo University Hospital, Oslo, Norway.
¹⁷ Department of Tumor Biology, Institute of Cancer Research, The Norwegian Radium Hospital, part of Oslo University Hospital, Oslo, Norway.
¹⁸ Center for Hereditary Tumors, HELIOS-Klinikum Wuppertal, University of Witten-Herdecke, Wuppertal, Germany.
¹⁹ Genomic Medicine Institute, Center for Personalised Genetic Healthcare, Cleveland Clinic, Cleveland, OH, USA.
²⁰ City of Hope National Medical Center, Duarte, CA, USA.
²¹ International Hereditary Cancer Center, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland.
²² Women's College Research Institute, Toronto, ON, Canada. steven.narod@wchospital.ca.
²³ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. steven.narod@wchospital.ca.

PMID: 30971774
PMCID: PMC6738089
DOI: 10.1038/s41416-019-0446-1

Abstract

Background: Women with a BRCA1 or BRCA2 mutation face high risks of breast and ovarian cancer. In the current study, we report on uptake of cancer screening and risk-reduction options in a cohort of BRCA mutation carriers from ten countries over two time periods (1995 to 2008 and 2009 to 2017).

Methods: Eligible subjects were identified from an international database of female BRCA mutation carriers and included women from 59 centres from ten countries. Subjects completed a questionnaire at the time of genetic testing, which included past use of cancer prevention options and screening tests. Biennial follow-up questionnaires were administered.

Results: Six-thousand two-hundred and twenty-three women were followed for a mean of 7.5 years. The mean age at last follow-up was 52.1 years (27-96 years) and 42.3% of the women had a prior diagnosis of breast cancer. In all, 27.8% had a prophylactic bilateral mastectomy and 64.7% had a BSO. Screening with breast MRI increased from 70% before 2009 to 81% at or after 2009. There were significant differences in uptake of all options by country.

Conclusion: For women who received genetic testing more recently, uptake of prophylactic mastectomy and breast MRI is significantly higher than those who received genetic testing more than 10 years ago. However, uptake of both BSO and breast MRI is not optimal, and interventions to increase uptake are needed.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig. 1**
The distribution of age of preventive mastectomy among subjects without breast cancer

**Fig. 2**
The distribution of age of preventive oophorectomy, a BRCA1 subjects, b BRCA2 subjects

See this image and copyright information in PMC

Comment in

Cancer screening and prevention in BRCA mutation carriers: a missed opportunity?
LeVasseur N, Chia S. LeVasseur N, et al. Br J Cancer. 2019 Jul;121(1):1-2. doi: 10.1038/s41416-019-0484-8. Epub 2019 Jun 7. Br J Cancer. 2019. PMID: 31171836 Free PMC article.

References

1. Kuchenbaecker KB, Hopper JL, Barnes DR, Phillips KA, Mooij TM, Roos-Blom MJ, et al. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA. 2017;317:2402–2416. doi: 10.1001/jama.2017.7112. - DOI - PubMed
1. NCCN Clinical Practice Guidelines in Oncology: Genetic/Familial High-Risk Assessment: Breast and Ovarian: National Comprehensive Cancer Network. (2018).
1. Finch A, Beiner M, Lubinski J, Lynch HT, Moller P, Rosen B, et al. Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 Mutation. JAMA. 2006;296:185–192. doi: 10.1001/jama.296.2.185. - DOI - PubMed
1. Finch Amy P.M., Lubinski Jan, Møller Pål, Singer Christian F., Karlan Beth, Senter Leigha, Rosen Barry, Maehle Lovise, Ghadirian Parviz, Cybulski Cezary, Huzarski Tomasz, Eisen Andrea, Foulkes William D., Kim-Sing Charmaine, Ainsworth Peter, Tung Nadine, Lynch Henry T., Neuhausen Susan, Metcalfe Kelly A., Thompson Islay, Murphy Joan, Sun Ping, Narod Steven A. Impact of Oophorectomy on Cancer Incidence and Mortality in Women With a BRCA1 or BRCA2 Mutation. Journal of Clinical Oncology. 2014;32(15):1547–1553. doi: 10.1200/JCO.2013.53.2820. - DOI - PMC - PubMed
1. Kriege M, Brekelmans CT, Boetes C, Besnard PE, Zonderland HM, Obdeijn IM, et al. Efficacy of MRI and mammography for breast-cancer screening in women with a familial or genetic predisposition. N. Engl. J. Med. 2004;351:427–437. doi: 10.1056/NEJMoa031759. - DOI - PubMed

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International trends in the uptake of cancer risk reduction strategies in women with a BRCA1 or BRCA2 mutation

Affiliations

International trends in the uptake of cancer risk reduction strategies in women with a BRCA1 or BRCA2 mutation

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous