Preferences of BRCA mutation carriers for attributes of risk-reducing surgical options for breast and ovarian cancer.

BACKGROUND

Risk-reducing surgeries are the most effective strategies for cancer prevention in patients with germline pathogenic variants in the BRCA1/BRCA2 genes; these surgeries are associated with early menopause, loss of childbearing potential, and cosmetic effects. The authors assessed women's preferences for tradeoffs related to risk-reducing surgical decision making.

METHODS

Carriers of pathogenic mutations in BRCA1/BRCA2 aged 25-50 years without a personal history of breast, ovarian, peritoneal, or tubal cancer were recruited to complete one of four discrete choice surveys based on their age (younger than 40 years or 40 years and older) and BRCA mutation status (BRCA1 or BRCA2). Participants responded to a series of choices between a do-nothing strategy and two profiles representing various effects of surgical options on menopause, childbearing potential (those younger than 40 years only), breast appearance, and 10-year and lifetime risks of breast and ovarian cancer. A conditional logit model was used to quantify participants' choices as a function of surgical options and outcomes.

RESULTS

In total, 298 participants completed the survey. Each cohort younger than <40 years more frequently chose profiles representing risk-reducing salpingo-oophorectomy (RRSO) at age 40 versus 30 years. The cohort aged 40 years and older with BRCA1 mutations favored RRSO at age 40 years but with a 56.6% choice probability of delayed RRSO after ages 35-40 years, as recommended by National Comprehensive Cancer Network guidelines. The cohort aged 40 and older with BRCA2 mutations favored RRSO at age 40, 45, or 50 years fairly equally, with a 33.0% choice probability of guideline-nonconcordant RRSO timing. All cohorts favored mastectomy at younger ages and with reconstruction versus no mastectomy.

CONCLUSIONS

These findings demonstrate the heterogeneity of preferences and support individualized discussion of treatment goals relating to risk-reducing surgical planning.