Determinants for or against prophylactic mastectomy and/or salpingo-oophorectomy in unaffected women with BRCA1 or BRCA2 pathogenic variants in Switzerland: A Mixed-Methods Study

Schweighoffer, R and Aceti, M and Caiata Zufferey, Maria and Baroutsou, V and Pedrazzani, Carla Ambrogina and Kim, S and Burki, N and Chappuis, P and Graffeo-Galbiati, R and Monnerat, C and Rabaglio, M and Katapodi, M (2022) Determinants for or against prophylactic mastectomy and/or salpingo-oophorectomy in unaffected women with BRCA1 or BRCA2 pathogenic variants in Switzerland: A Mixed-Methods Study. In: 11th Global Breast Cancer Conference, 28-30.4.2022, Seoul, South Korea.

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Abstract

Background: Women carrying pathogenic variants in BRCA1 and BRCA2 have significantly higher risk of breast or ovarian cancer. Prophylactic surgeries (PS), such as mastectomy and/or salpingo-oophorectomy are documented cancer prevention methods, recommended by national and international guidelines. However, decisions for PS are not trivial, and women are often exposed to conflicting information from internet forums, websites, their social network, and even healthcare providers. There is limited evidence on how women with BRCA1/ BRCA2 pathogenic variants decide for or against PS. Method: Unaffected women with BRCA1/BRCA2 pathogenic variants (n=109) completed a baseline survey as part of their participation to the Swiss CASCADE study, an open- family-based cohort focused on hereditary cancer. A subsample of unaffected women (n=16) provided in-depth interviews. The survey and the interviews were designed to elicit factors influencing decisions for genetic testing and cancer risk management. Descriptive statistics and multivariate analysis identified the predictive value of demographic, clinical, and psychosocial variables. Findings were enriched with inductive analysis of narrative data using grounded theory. Results: Analyses are ongoing. Younger women (<50y.o.) and those with higher self-rated genetic literacy appear more likely to opt for prophylactic mastectomy. Women with children and those >50y.o.opt more often for salpingo-oophorectomy. Narrative data point to self-protection, self-image, relationship, sexuality, fertility, and adverse events. Conclusions: Understanding reasoning and worries relating to PS, healthcare professionals will be able to improve consultations and better address age- and gender-specific concerns.

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