Cost-effectiveness and comparative effectiveness of cancer risk management strategies in BRCA1/2 mutation carriers: a systematic review

IntroductionWomen who inherit a pathogenic mutation in Breast Cancer Susceptibility Genes 1 or 2 (BRCA1 or BRCA2) are at substantially higher risk of developing breast and ovarian cancer than the average woman. Several cancer risk management strategies exist to address this increased risk. Decisions about which risk management strategies to choose are complex, personal and multifactorial for these women. This scoping review will map evidence relevant to cancer risk management decision making in BRCA mutation carriers without a personal history of cancer. The objective is to identify and describe the features of patient decision aids that have been developed for BRCA mutation carriers. This information may be beneficial for designing new decision aids or adapting existing decision aids to support decision making in this population.Methods and analysisThis scoping review will be conducted according to the Joanna Briggs Institute’s scoping review methodological framework. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist will be used for guidance. Studies on decision aids for women with a BRCA mutation who are unaffected by breast or ovarian cancer will be considered for inclusion. Five electronic databases will be searched (MEDLINE, EMBASE, Cochrane Library, CINAHL, Web of Science) with no restrictions applied for language or publication date. Studies for inclusion will be selected independently by two review authors. Data will be extracted using a predefined data extraction form. Findings will be presented in tabular form. A narrative description of the evidence will complement the tabulated results.Ethics and disseminationEthical approval for conducting this scoping review is not required as this study will involve secondary analysis of existing literature. Findings will be published in a peer-reviewed journal and presented at relevant conferences.

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Cancer risk management strategies and perceptions of unaffected women 5 years after predictive genetic testing for BRCA1/2 mutations

European Journal of Human Genetics ◽

10.1038/ejhg.2010.241 ◽

2011 ◽

Vol 19 (5) ◽

pp. 500-506 ◽

Cited By ~ 32

Author(s):

Claire Julian-Reynier ◽

Julien Mancini ◽

Emmanuelle Mouret-Fourme ◽

Marion Gauthier-Villars ◽

Valérie Bonadona ◽

...

Keyword(s):

Risk Management ◽

Genetic Testing ◽

Cancer Risk ◽

Management Strategies ◽

Predictive Genetic Testing ◽

Risk Management Strategies ◽

Cancer Risk Management

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Cost-effectiveness as a factor in cancer risk management

Environment International ◽

10.1016/0160-4120(87)90008-0 ◽

1987 ◽

Vol 13 (6) ◽

pp. 469-474 ◽

Cited By ~ 3

Author(s):

C.C. Travis ◽

S.Richter Pack ◽

A. Fisher

Keyword(s):

Risk Management ◽

Cost Effectiveness ◽

Cancer Risk ◽

Cancer Risk Management

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BIA-ALCL and Textured Breast Implants: A Systematic Review of Evidence Supporting Surgical Risk Management Strategies

Plastic & Reconstructive Surgery ◽

10.1097/prs.0000000000008040 ◽

2021 ◽

Vol 147 (5S) ◽

pp. 7S-13S

Author(s):

Jonas A. Nelson ◽

Colleen McCarthy ◽

Stefan Dabic ◽

Thais Polanco ◽

Marina Chilov ◽

...

Keyword(s):

Systematic Review ◽

Risk Management ◽

Management Strategies ◽

Breast Implants ◽

Surgical Risk ◽

Risk Management Strategies

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Individualized Survival Curves Improve Satisfaction With Cancer Risk Management Decisions in Women With BRCA1/2 Mutations

Journal of Clinical Oncology ◽

10.1200/jco.2005.06.119 ◽

2005 ◽

Vol 23 (36) ◽

pp. 9319-9328 ◽

Cited By ~ 27

Author(s):

Katrina Armstrong ◽

Barbara Weber ◽

Peter A. Ubel ◽

Nikki Peters ◽

John Holmes ◽

...

Keyword(s):

Risk Management ◽

Cancer Risk ◽

Management Strategies ◽

Ovarian Cancer Risk ◽

Management Decisions ◽

Management Options ◽

Alternative Management ◽

Decision Satisfaction ◽

Cancer Risk Management

Purpose Women with BRCA1/2 mutations are faced with complex decisions about breast and ovarian cancer risk management. This study was conducted to determine the effect of a tailored decision support system (DSS) that provides individualized survival and cancer incidence curves specific to expected outcomes of alternative management strategies. Patients and Methods This was a double-blind, randomized controlled trial of 32 women with BRCA1/2 mutations. Primary outcome measures were decision satisfaction, cancer anxiety, perceptions of cancer risk given alternative management strategies, and management decisions. Results Twenty-seven women completed a 6-week follow-up. Women in the intervention arm (n = 13) reported significantly higher decision satisfaction at follow-up than women in the control arm (n = 14; adjusted mean difference, 9.7; P < .0005). The effect of the DSS was greater among women with low cancer anxiety at baseline than women with high cancer anxiety at baseline (P = .01 for interaction). However, the DSS did not significantly alter cancer anxiety at follow-up, perceptions of cancer risk given alternative management strategies, or management decisions. Conclusion The presentation of individualized survival and incidence curves for alternative management options improves satisfaction about cancer risk management decisions among women with BRCA1/2 mutations without increasing anxiety or changing management decisions. The benefit of the DSS is greatest among women with relatively low cancer-related anxiety at baseline.

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CN19 BRCA mutation carriers’ and stakeholders’ perspectives on cancer risk management and decision-making: A qualitative study

Annals of Oncology ◽

10.1016/j.annonc.2021.08.644 ◽

2021 ◽

Vol 32 ◽

pp. S1262

Author(s):

M. Polus ◽

Y. Hanhauser ◽

S. McGarrigle ◽

C. Spillane ◽

N. Byrne ◽

...

Keyword(s):

Decision Making ◽

Risk Management ◽

Qualitative Study ◽

Cancer Risk ◽

Brca Mutation ◽

Mutation Carriers ◽

Brca Mutation Carriers ◽

Cancer Risk Management

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Uptake of cancer risk management strategies among women who undergo cascade genetic testing for breast cancer susceptibility genes

Cancer ◽

10.1002/cncr.33668 ◽

2021 ◽

Author(s):

Sukh Makhnoon ◽

Grace Tran ◽

Brooke Levin ◽

Kristin D. Mattie ◽

Brian Dreyer ◽

...

Keyword(s):

Breast Cancer ◽

Risk Management ◽

Genetic Testing ◽

Cancer Susceptibility ◽

Management Strategies ◽

Breast Cancer Susceptibility ◽

Cancer Susceptibility Genes ◽

Breast Cancer Susceptibility Genes ◽

Risk Management Strategies ◽

Cancer Risk Management

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Patient-Reported Outcome Measures may optimize shared decision-making for cancer risk management in BRCA mutation carriers

Breast Cancer ◽

10.1007/s12282-019-01033-7 ◽

2019 ◽

Vol 27 (3) ◽

pp. 426-434

Author(s):

L. S. E. van Egdom ◽

M. A. de Kock ◽

I. Apon ◽

M. A. M. Mureau ◽

C. Verhoef ◽

...

Keyword(s):

Decision Making ◽

Risk Management ◽

Cancer Risk ◽

Shared Decision Making ◽

Well Being ◽

Shared Decision ◽

Mutation Carriers ◽

Patient Reported ◽

One Year ◽

Cancer Risk Management

Abstract Purpose The aim of this study was to compare patient-reported outcomes (PROs) of BRCA1/2 mutation carriers, either after bilateral prophylactic mastectomy (BPM) or during breast surveillance, to improve shared decision-making in their cancer risk management. Methods Unaffected BRCA1/2 mutation carriers at least one year after BPM followed by immediate breast reconstruction (BPM-IBR) or one year under surveillance were eligible. After informed consent, the Hospital Anxiety and Depression Scale (HADS) and BREAST-Q were administered and compared between the different strategies. PROs were also compared to available normative data. Results Ninety-six participants were analyzed in this study and showed significant differences between strategies in age, age at genetic testing, and time since BPM or starting breast surveillance. All HADS scores were below 8 suggesting no signs of anxiety or depression in both groups. Higher mean ‘Q-physical well-being’ scores were reported by the surveillance group (81.78 [CI 76.99–86.57]) than the BPM group (76.96 [CI 73.16 – 80.75]; p = 0.011). Overall, for both questionnaires better scores were seen when compared to age-matched normative data. Conclusions No signs of anxiety or depression were seen in the surveillance or BPM-IBR group. Slightly better mean BREAST-Q scores were seen for the surveillance group in comparison to BPM-IBR, except for ‘Q-psychological well-being’. The difference in ‘Q-physical well-being’ was significantly worse for BPM-IBR. Approaches to obtain longitudinal PROs and reference values should be explored in the future, which could add value to shared decision-making in regards to breast cancer risk management in this specific patient population.

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