Breast Cancer Risk Reduction Decisions of the BRCA -Positive Patient: An Observational Study at a Single Institution

Abstract

Background:

BRCA1 and BRCA2 gene mutations carry with them a 50%–80% risk of developing breast cancer. The best choice for managing breast cancer risk in patients with a BRCA1/2 mutation is a highly personal decision. Options for risk management include surveillance with multiple modalities or prophylactic surgical intervention. The goal of this study was to gain a better understanding of contributing factors affecting the decision for managing breast cancer risk made by patients who are BRCA mutation positive and cancer free.

Methods:

A retrospective chart review of patients, who tested positive for BRCA1/2 gene mutation between 2003 and 2013 without history of breast cancer, was performed. A logistic regression model was used to assess the association between preselected risk factors and the decision of the patient to undergo prophylactic mastectomy versus surveillance.

Results:

Of the 106 patients who were cancer free and BRCA positive, seventy (66%) opted for surveillance, whereas 36 (34%) chose prophylactic mastectomy. Three preselected risk factors were found to significantly affect a patient's likelihood of choosing surgery: having a family member with breast cancer before the age of 50 (OR: 4.67 [95% CI: 1.86–11.68]), p = 0.001), cancer-related death of a relative younger than 50 years old (OR: 2.26 [95% CI: 0.92–5.55], p = 0.07), and prophylactic oophorectomy before planned mastectomy (OR: 3.72 [95% CI: 1.49–9.31], p = 0.005). Patient age less than 30 was found to be significantly associated with the decision to proceed with surveillance (OR: 0.2 [95% CI: 0.05–0.75], p = 0.02).

Conclusion:

Risk-reducing strategy is a very personal decision for the patient with positive BRCA mutation, and many factors go into choosing which options are best for each individual. We found that age of patient, relative with breast cancer or death of a relative before age 50, and prophylactic oophorectomy all play significant roles in which risk reduction strategy is chosen.