Breast Cancer, BRCA Mutations, and Attitudes Regarding Pregnancy and Preimplantation Genetic Diagnosis

• Published in: The oncologist (Dayton, Ohio) Vol. 19; no. 8; pp. 797 - 804
• Main Authors: Woodson, Ashley H., Muse, Kimberly I., Lin, Heather, Jackson, Michelle, Mattair, Danielle N., Schover, Leslie, Woodard, Terri, McKenzie, Laurie, Theriault, Richard L., Hortobágyi, Gabriel N., Arun, Banu, Peterson, Susan K., Profato, Jessica, Litton, Jennifer K.
• Format: Journal Article
• Language: English
• Published: Durham, NC, USA AlphaMed Press 01-08-2014
• Subjects: Adult; BRCA; BRCA1 Protein - genetics; BRCA2 Protein - genetics; Breast Cancer; Breast Neoplasms - epidemiology; Breast Neoplasms - genetics; Breast Neoplasms - pathology; Female; Fertility; Genetic Predisposition to Disease; Genetic Testing; Genetics; Humans; Infertility, Female - genetics; Infertility, Female - pathology; Middle Aged; Mutation; Pregnancy; Preimplantation Diagnosis; Preimplantation genetic diagnosis; Surveys and Questionnaires; BRCA; Genetics; Breast cancer; Preimplantation genetic diagnosis; Fertility
• ISSN: 1083-7159; 1549-490X
• DOI: 10.1634/theoncologist.2014-0057

Background.
Women with premenopausal breast cancer may face treatment‐related infertility and have a higher likelihood of a BRCA mutation, which may affect their attitudes toward future childbearing.
Methods.
Premenopausal women were invited to participate in a questionnaire study administered before and after BRCA genetic testing. We used the Impact of Event Scale (IES) to evaluate the pre‐ and post‐testing impact of cancer or carrying a BRCA mutation on attitudes toward future childbearing. The likelihood of pursuing prenatal diagnosis (PND) or preimplantation genetic diagnosis (PGD) was also assessed in this setting. Univariate analyses determined factors contributing to attitudes toward future childbearing and likelihood of PND or PGD.
Results.
One hundred forty‐eight pretesting and 114 post‐testing questionnaires were completed. Women with a personal history of breast cancer had less change in IES than those with no history of breast cancer (p = .003). The 18 BRCA‐positive women had a greater change in IES than the BRCA‐negative women (p = .005). After testing, 31% and 24% of women would use PND and PGD, respectively. BRCA results did not significantly affect attitudes toward PND/PGD.
Conclusion.
BRCA results and history of breast cancer affect the psychological impact on future childbearing. Intentions to undergo PND or PGD do not appear to change after disclosure of BRCA results. Additional counseling for patients who have undergone BRCA testing may be warranted to educate patients about available fertility preservation options.
摘要
背景。患有绝经前乳腺癌的女性可能面临患上与治疗相关之不孕症的风险，且出现 BRCA 突变的可能性更高，这可能影响她们对未来生育孩子的态度。
方法。绝经前女性受邀参与一项问卷调查研究，该研究在 BRCA 基因检测之前和之后分别施行。我们使用了事件影响量表 (IES) ，在检测前和检测后对癌症或携带 BRCA 突变会对未来生育孩子之态度产生何种影响作了评估。在此设置环境下，也对寻求产前诊断 (PND) 或植入前遗传学诊断 (PGD) 的可能性作了评估。单因素分析确定了有助于促成未来愿意生育孩子以及愿意寻求 PND 或 PGD 的因素。
结果。完成了 148 份检测前和 114 份检测后调查问卷。有乳腺癌个人病史的女性的 IES 变化小于没有乳腺癌史的女性 (p = 0.003)。18 名 BRCA 为阳性之女性的 IES 变化大于 BRCA 为阴性的女性 (p = 0.005)。检测之后，分别有 31% 和 24% 的女性会使用 PND 和 PGD。BRCA 结果并未显著影响对使用 PND/PGD 的态度。
结论。BRCA 结果和乳腺癌史会对未来生育孩子的态度产生心理影响。接受 PND 或 PGD 的意向在披露 BRCA 结果后似乎没有改变。可能需要对接受 BRCA 检测的患者提供额外咨询，以让患者了解可用于保护生育能力的方案选项。 (The Oncologist) 2014;19:797–804
The purpose of this study was to evaluate how BRCA genetic test result disclosure and patient characteristics influence attitudes about preimplantation genetic diagnosis (PGD), prenatal diagnosis (PND), and future childbearing. Intentions to undergo PND or PGD do not appear to change after disclosure of BRCA results. Additional counseling for patients who have undergone BRCA testing may be warranted to educate patients about available fertility preservation options.