Socioeconomic Factors Influencing BRCA 1/2 Mutation Carriers To Choose Risk Reduction Surgery in Community Cancer Genetics Program.

Abstract

Abstract Background: Mutations in the BRCA 1/2 genes predispose women to increased risk of breast and ovarian cancer. Prophylactic mastectomy (PM) reduces the risk of breast cancer by approximately 90% while prophylactic salpingo-oophorectomy (PSO) reduces the risk of both breast and ovarian cancer. Yet, there is a paucity of data to determine if mutation carriers avail themselves of these risk reducing surgeries in the community setting.Purpose: This study evaluates if particular socioeconomic factors influence BRCA 1/2 mutation carriers to elect risk reduction surgery (RRS), either PM or PSO or both.Method: Of 129 BRCA1/2 positive patients identified by a community-based cancer genetics program outside Philadelphia from 1998 to 2008, 44 were excluded due to personal history of ovarian cancer, loss of follow-up, male gender, or deceased status. The 85 remaining patients were asked to complete a questionnaire addressing: age at diagnosis, ethnicity, religion, parity, education level, marital status, occupation, number of first degree relatives with breast or ovarian cancer, personal history of breast cancer, and use of oral contraceptives, tobacco, and alcohol. A chart review was performed on all responders.Results: Forty-nine patients (58%) completed the questionnaire. Of these, 68% (34/49) had RRS. Of those who did not have RRS, 63% (10/15) stated they definitely plan for RRS in the future. More than half of the women planning RRS in the future (6/10) were younger than 30 years old. Therefore, of all responders, 90% (44/49) stated they had or definitely plan to have RRS. The mean age of women with RRS versus those without was 43.9 and 35.6 years, respectively (p=.0102). Women age 40-64 had the highest rate of RRS (26/34; 84%; p=0.004). Most women (88%) with RRS had children (30/34; p=0.0493). Sixty-five percent (32/49) of women responders were college graduates; 24% were high school graduates (12/49). Of women who had RRS, 68% were college graduates. College graduates age > 40 were the group most likely to have RRS (17/18; 94%; p= .00029). Only 63% of high school graduates age > 40 (5/8; p=1.0) had RRS. Eight-five percent (11/13) of Ashkenazi Jewish women had RRS versus 67% (18/27) of non-Jewish Caucasian women. This was not statistically significant (p=0.2925). There was also no statistical difference for women choosing RRS with respect to occupation, birth control pill use, history of breast cancer, or family history of breast or ovarian cancer. Only 3/49 smoked cigarettes (>more than 1 pack per week) and none drank alcohol (>1 drink/day).Discussion: Women who presented to this community based genetics program had a high rate of RRS, were likely to be college educated, non-smokers, and non-drinkers. Age older than 40, completion of child bearing, and attainment of a college degree were the most significant factors associated with BRCA 1/2 mutation carriers having RRS. Further studies should explore barriers to genetic testing services, as well as evaluate reasons why BRCA1/2 mutation carriers decline RRS. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4076.