Association of personal and family history with decision to undergo risk-reducing salpingo-oophorectomy in BRCA mutation carriers

Abstract

9560 Background: BRCA mutations carriers are at substantially increased risk to develop both breast and ovarian cancer. Current risk-reduction recommendations include consideration of risk-reducing salpingo-oophorectomy (RRSO) once childbearing is complete. Despite evidence supporting the efficacy of this approach, many patients do not pursue this option. In order to further evaluate this issue, we examined predictors of RRSO uptake in a large cohort of prospectively ascertained BRCA mutation carriers. Methods: Medical records of all women with a BRCA1 or BRCA2 mutation identified between 6/1995 and 12/2003 with ovarian tissue at risk and enrolled on one of two prospective follow-up studies were evaluated. Univariate analysis of demographic variables hypothesized to be predictive of RRSO uptake was performed. Variables significant in univariate analysis were analyzed in a multivariate logistic regression model. Results: Of 339 women meeting the study criteria, 213 (62.8%) elected to undergo RRSO after receiving genetic testing results. On univariate analysis, age ≥ 40 (Odds Ratio (OR) 5.99, 95% CI [3.67, 9.78]}, personal history of breast cancer (OR 2.09, [1.33, 3.27]), parity (OR 2.43, [1.49, 3.94]) and post-menopausal status (OR 3.11, [1.89, 5.13]) were predictive of uptake of RRSO. Family history of breast (OR 0.72, [0.46, 1.13]) or ovarian cancer (OR 1.60, [0.87, 3.00]) in a 1st degree relative was not predictive of RRSO uptake. On multivariate analysis, only age ≥ 40 (OR 4.92, [2.69, 9.00]) or history of a live birth (OR 2.25, [1.29, 3.90]) were predictive of uptake of RRSO. Conclusions: The decision to undergo RRSO in BRCA mutation carriers was not significantly impacted by personal history of breast cancer or family history of breast or ovarian cancer. Thus, other factors most likely play a central role. Given the high uptake of RRSO in this series, it appears that risk notification based in genetic counseling is highly effective in influencing preventive behaviors, independently of all other factors except age and parity. No significant financial relationships to disclose.