Time to prophylactic surgery in BRCA1/2 carriers depends on psychological and other characteristics

• Published in: Genetics in medicine Vol. 12; no. 12; pp. 801 - 807
• Main Authors: Julian-Reynier, Claire, Bouhnik, Anne-Déborah, Mouret-Fourme, Emanuelle, Gauthier-Villars, Marion, Berthet, Pascaline, Lasset, Christine, Fricker, Jean-Pierre, Caron, Olivier, Gesta, Paul, Luporsi, Elisabeth, Faivre, Laurence, Longy, Michel, Gladieff, Laurence, Frenay, Marc, Dreyfus, Héléne, Sobol, Hagay, Vennin, Philippe, Nogués, Catherine
• Format: Journal Article
• Language: English
• Published: New York Elsevier Inc 01-12-2010; Nature Publishing Group US; Nature Publishing Group
• Subjects: Adult; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; BRCA1/2; breast cancer; Breast Neoplasms - genetics; Breast Neoplasms - psychology; Breast Neoplasms - surgery; Family Characteristics; Female; France; Genes, BRCA1; Genes, BRCA2; genetic testing; Heterozygote; Human Genetics; Humans; Kaplan-Meier Estimate; Laboratory Medicine; Life Sciences; Mastectomy; Medical sciences; Middle Aged; Miscellaneous; Mutation - genetics; Ovarian Neoplasms - genetics; Ovarian Neoplasms - psychology; Ovarian Neoplasms - surgery; Ovariectomy; prophylactic surgery; Prospective Studies; psychosocial; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Time Factors; France; BRCA1/2; psychosocial; breast cancer; genetic testing; prophylactic surgery; Human; Malignant tumor; Woman; Surgery; Care; Cancer
• ISSN: 1098-3600; 1530-0366
• DOI: 10.1097/GIM.0b013e3181f48d1c

To investigate the medical and psychosocial factors determining the time to prophylactic surgery of unaffected women carriers of a deleterious BRCA1/2 mutation.
Prospective study on a French national cohort of unaffected BRCA1/2 carriers (N = 244); multivariate Cox proportional hazard modeling.
Median follow-up time was 2.33 years (range, 0.04–6.84 years). Time to surgery was shorter when the psychological impact of BRCA1/2 result disclosure was stated to be higher (P ≤ 0.01). Those who intended to opt for prophylactic surgery before being tested did so faster and more frequently after test disclosure than those who were undecided/opposed. The older the women were, the faster their uptake of risk-reducing salpingo-oophorectomy (adjusted hazard ratio >2.95; P < 0.001) was; the uptake of those with at least two children was also faster (adjusted hazard ratio = 2.51; [1.38–4.55]). Those who opted most quickly for risk-reducing mastectomy more frequently had a younger child at the time of testing (adjusted hazard ratio = 4.63 [1.56–13.74]). Time to surgery was shorter when there was a first-degree relative with ovarian/breast cancer (P ≤ 0.01).
Time to prophylactic surgery depends on the stated psychological impact of disclosure and on women's cognitive anticipation of surgery after adjusting on sociodemographic characteristics.