Difference of Opinion: Spousal Influence on Cancer Risk-reducing Behavior

Abstract Risk-reducing mastectomy (RRM) and salpingo-oophorectomy (RRSO) are increasingly used to reduce breast and ovarian cancer risk following BRCA1/BRCA2 testing. However, little is known about how genetic counseling influences decisions about these surgeries. Although previous studies have examined intentions prior to counseling, few have examined RRM and RRSO intentions in the critical window between genetic counseling and test result disclosure. Previous research has indicated that intentions at this time point predict subsequent uptake of surgery, suggesting that much decision-making has taken place prior to result disclosure. This period may be a critical time to better understand the drivers of prophylactic surgery intentions. The aim of this study was to examine predictors of RRM and RRSO intentions. We hypothesized that variables from the Health Belief Model would predict intentions, and we also examined the role of affective factors. Participants were 187 women, age 21–75, who received genetic counseling for hereditary breast and ovarian cancer. We utilized multiple logistic regression to identify independent predictors of intentions. 49.2% and 61.3% of participants reported intentions for RRM and RRSO, respectively. Variables associated with RRM intentions include: newly diagnosed with breast cancer (OR = 3.63, 95% CI = 1.20–11.04), perceived breast cancer risk (OR = 1.46, 95% CI = 1.17–1.81), perceived pros (OR = 1.79, 95% CI = 1.38–2.32) and cons of RRM (OR = 0.81, 95% CI = 0.65–0.996), and decision conflict (OR = 0.80, 95% CI = 0.66–0.98). Variables associated with RRSO intentions include: proband status (OR = 0.28, 95% CI = 0.09–0.89), perceived pros (OR = 1.35, 95% CI = 1.11–1.63) and cons of RRSO (OR = 0.72, 95% CI = 0.59–0.89), and ambiguity aversion (OR = 0.79, 95% CI = 0.65–0.95). These data provide support for the role of genetic counseling in fostering informed decisions about risk management, and suggest that the role of uncertainty should be explored further.

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Risk-Reducing Oophorectomy and Breast Cancer Risk Across the Spectrum of Familial Risk

JNCI Journal of the National Cancer Institute ◽

10.1093/jnci/djy182 ◽

2018 ◽

Vol 111 (3) ◽

pp. 331-334 ◽

Cited By ~ 11

Author(s):

Mary Beth Terry ◽

Mary B Daly ◽

Kelly Anne Phillips ◽

Xinran Ma ◽

Nur Zeinomar ◽

...

Keyword(s):

Breast Cancer ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Familial Risk ◽

Risk Reducing

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Women’s intentions to engage in risk-reducing behaviours after receiving personal ovarian cancer risk information: an experimental survey study

10.31234/osf.io/jqu87 ◽

2019 ◽

Author(s):

Ailish Gallagher ◽

Jo Waller ◽

Ranjit Manchanda ◽

Ian Jacobs ◽

Saskia Sanderson

Keyword(s):

Ovarian Cancer ◽

Cancer Risk ◽

Risk Stratification ◽

Perceived Risk ◽

Lifestyle Factors ◽

Cancer Risk Assessment ◽

Survey Study ◽

Ovarian Cancer Risk ◽

Risk Reducing ◽

Experimental Survey

Risk stratification using genetic and/or other types of information could identify women at increased ovarian cancer risk. The aim of this study was to examine women’s potential reactions to ovarian cancer risk stratification. 1,017 women aged 45-75 years took part in an online experimental survey. Women were randomly assigned to one of three experimental conditions describing hypothetical personal results from ovarian cancer risk stratification, and asked to imagine they had received one of three results: (a) 5% risk due to SNPs and lifestyle factors; (b) 10% risk due to SNPs and lifestyle factors; (c) 10% risk due to a rare mutation in BRCA2. 83% of women indicated interest in having ovarian cancer risk assessment. After receiving their hypothetical risk estimates, 29% of women stated they would have risk-reducing surgery. Choosing risk-reducing surgery over other behavioural responses was associated with having higher surgery self-efficacy and perceived response-efficacy, but not with perceptions of disease threat, i.e. perceived risk or severity, or with experimental condition. A substantial proportion of women age 45-75 years may be open to the idea of surgery to reduce risk of ovarian cancer, even if their absolute lifetime risk is only increased to as little as 5 or 10%.

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Considerations in Management for Trans and Gender Diverse Patients with Inherited Cancer Risk

Current Genetic Medicine Reports ◽

10.1007/s40142-021-00201-6 ◽

2021 ◽

Author(s):

Beth Coad ◽

Josephine Giblin ◽

Reubs J. Walsh ◽

Oliwia Kuczkowska ◽

Alexander M. von Vaupel-Klein ◽

...

Keyword(s):

Cancer Risk ◽

Best Practice ◽

Cancer Genetics ◽

National Guidelines ◽

Inherited Cancer ◽

Gender Diverse ◽

Individualised Care ◽

And Gender ◽

The Impact ◽

Risk Reducing

Abstract Purpose of Review To best support all patients with inherited cancer risk, we must broaden our scope of practice to consider the needs of the transgender and gender diverse (trans) community. We considered best practice for supporting trans patients including tailored risk assessments and management recommendations. Recent Findings There is limited literature considering trans patient care in cancer genetics. Small case studies have highlighted how medical transition and cancer risk–reducing options intersect with the need for individualised care. Studies have also shown that cancer genetics professionals do not feel prepared to support trans patients. Summary Patient-centred care for trans patients relies on a multidisciplinary team (MDT) engaged in shared decision-making. National guidelines are needed to standardise access to appropriate discussions around risk-reducing options and screening. International collaborative research is required to provide empiric data on the impact of gender-affirming treatments on cancer risk, and more experiential data is needed from trans patients accessing cancer genetics services. Finally, education and training in this area should be formally embedded for all cancer genetics professionals.

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Hormone replacement therapy after prophylactic risk-reducing salpingo-oophorectomy and breast cancer risk in BRCA1 and BRCA2 mutation carriers: A meta-analysis

Critical Reviews in Oncology/Hematology ◽

10.1016/j.critrevonc.2018.09.018 ◽

2018 ◽

Vol 132 ◽

pp. 111-115 ◽

Cited By ~ 15

Author(s):

C. Marchetti ◽

F. De Felice ◽

S. Boccia ◽

C. Sassu ◽

V. Di Donato ◽

...

Keyword(s):

Breast Cancer ◽

Hormone Replacement Therapy ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Replacement Therapy ◽

Meta Analysis ◽

Hormone Replacement ◽

Brca2 Mutation ◽

Brca1 And Brca2 ◽

Risk Reducing

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Risk-Reducing Salpingo-Oophorectomy and Breast Cancer Risk Reduction in the Gynecologic Oncology Group Protocol-0199 (GOG-0199)

JNCI Cancer Spectrum ◽

10.1093/jncics/pkz075 ◽

2019 ◽

Vol 4 (1) ◽

Cited By ~ 2

Author(s):

Phuong L Mai ◽

Austin Miller ◽

Mitchell H Gail ◽

Steven Skates ◽

Karen Lu ◽

...

Keyword(s):

Breast Cancer ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Cancer Incidence ◽

Breast Cancer Incidence ◽

Incidence Rates ◽

Pathogenic Variant ◽

Risk Reducing ◽

Cancer Risk Reduction

Abstract Background Risk-reducing salpingo-oophorectomy (RRSO) has been associated with approximately 50% breast cancer risk reduction among women with a pathogenic variant in BRCA1 or BRCA2 (BRCA1/2), a finding that has recently been questioned. Methods We estimated incidence rates of breast cancer and all cancers combined during 5 years of follow-up among participants selecting RRSO or ovarian cancer screening (OCS) among women with a BRCA1/2 pathogenic variant or strong breast and/or ovarian cancer family history. Ovarian or fallopian tube or peritoneal cancer incidence rates were estimated for the OCS group. Breast cancer hazard ratios (HRs) for time-dependent RRSO were estimated using Cox regression with age time-scale (4943 and 4990 women-years in RRSO and OCS cohorts, respectively). All statistical tests were two-sided. Results The RRSO cohort included 925 participants, and 1453 participants were in the OCS cohort (381 underwent RRSO during follow-up), with 88 incident breast cancers diagnosed. Among BRCA1/2 pathogenic variant carriers, a non-statistically significant lower breast cancer incidence was observed in the RRSO compared with the OCS cohort (HR = 0.86, 95% confidence interval = 0.45 to 1.67; P = .67). No difference was observed in the overall population or among subgroups stratified by prior breast cancer history or menopausal status. Seven fallopian tube and four ovarian cancers were prospectively diagnosed in the OCS cohort, and one primary peritoneal carcinoma occurred in the RRSO cohort. Conclusions These data suggest that RRSO might be associated with reduced breast cancer incidence among women with a BRCA1/2 pathogenic variant, although the effect, if present, is small. This evolving evidence warrants a thorough discussion regarding the impact of RRSO on breast cancer risk with women considering this intervention.

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Impact of genetic testing on endometrial cancer risk-reducing practices in women at risk for Lynch syndrome

Gynecologic Oncology ◽

10.1016/j.ygyno.2012.08.031 ◽

2012 ◽

Vol 127 (3) ◽

pp. 544-551 ◽

Cited By ~ 15

Author(s):

Matthew B. Yurgelun ◽

Rowena Mercado ◽

Margery Rosenblatt ◽

Monica Dandapani ◽

Wendy Kohlmann ◽

...

Keyword(s):

At Risk ◽

Endometrial Cancer ◽

Genetic Testing ◽

Cancer Risk ◽

Lynch Syndrome ◽

Endometrial Cancer Risk ◽

Risk Reducing

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Association of Risk-Reducing Surgery in BRCA1 or BRCA2 Mutation Carriers With Cancer Risk and Mortality

Yearbook of Obstetrics Gynecology and Women s Health ◽

10.1016/j.yobg.2011.05.038 ◽

2011 ◽

Vol 2011 ◽

pp. 470-473

Author(s):

J.S. Dungan

Keyword(s):

Cancer Risk ◽

Brca2 Mutation ◽

Mutation Carriers ◽

Risk Reducing

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Bilateral Risk-Reducing Oophorectomy in BRCA1 and BRCA2 Mutation Carriers

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2006.0017 ◽

2006 ◽

Vol 4 (2) ◽

pp. 177-182 ◽

Cited By ~ 19

Author(s):

Susan M. Domchek ◽

Jill E. Stopfer ◽

Timothy R. Rebbeck

Keyword(s):

Breast Cancer ◽

Breast Cancer Risk ◽

Cancer Risk ◽

Risk Reduction ◽

Hormone Replacement ◽

Brca2 Mutation ◽

Ovarian Cancer Risk ◽

Mutation Carriers ◽

Risk Reducing ◽

Cancer Risk Reduction

Bilateral risk-reducing oophorectomy (BRRO) is widely used for cancer risk reduction in women with BRCA1 and BRCA2 (BRCA1/2) mutations. BRRO significantly reduces breast cancer risk by approximately 50% and ovarian cancer risk by 85% to 95%, but it may be accompanied by menopausal symptoms, impaired quality of life, and accelerated bone loss. Therefore, decisions regarding the timing of BRRO, the risks and benefits of a simultaneous hysterectomy, and the use of hormone replacement therapy (HRT) must be made in concert with the patient and individualized to their circumstances. However, recent data demonstrate that HRT after BRRO in unaffected premenopausal women does not negate the breast cancer risk reduction that BRRO provides. This article reviews the studies regarding BRRO in BRCA1/2 mutation carriers, with particular focus on the use of HRT.

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