Liede Alexander, Mansfield Carol A, Metcalfe Kelly A, Price Melanie A, Snyder Carrie, Lynch Henry T, Friedman Sue, Amelio Justyna, Posner Joshua, Narod Steven A, Lindeman Geoffrey J, Evans D Gareth
Amgen Inc, South San Francisco, CA, USA.
RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC, 27709, USA.
Breast Cancer Res Treat. 2017 Sep;165(2):433-444. doi: 10.1007/s10549-017-4332-3. Epub 2017 Jun 17.
Unaffected women who carry BRCA1 or BRCA2 mutations face difficult choices about reducing their breast cancer risk. Understanding their treatment preferences could help us improve patient counseling and inform drug trials. The objective was to explore preferences for various risk-reducing options among women with germline BRCA1/2 mutations using a discrete-choice experiment survey and to compare expressed preferences with actual behaviors.
A discrete-choice experiment survey was designed wherein women choose between hypothetical treatments to reduce breast cancer risk. The hypothetical treatments were characterized by the extent of breast cancer risk reduction, treatment duration, impact on fertility, hormone levels, risk of uterine cancer, and ease and mode of administration. Data were analyzed using a random-parameters logit model. Women were also asked to express their preference between surgical and chemoprevention options and to report on their actual risk-reduction actions. Women aged 25-55 years with germline BRCA1/2 mutations who were unaffected with breast or ovarian cancer were recruited through research registries at five clinics and a patient advocacy group.
Between January 2015 and March 2016, 622 women completed the survey. Breast cancer risk reduction was the most important consideration expressed, followed by maintaining fertility. Among the subset of women who wished to have children in future, the ability to maintain fertility was the most important factor, followed by the extent of risk reduction. Many more women said they would take a chemoprevention drug than had actually taken chemoprevention.
Women with BRCA1/2 mutations indicated strong preferences for breast cancer risk reduction and maintaining fertility. The expressed desire to have a safe chemoprevention drug available to them was not met by current chemoprevention options.
携带BRCA1或BRCA2基因突变的未患癌女性在降低乳腺癌风险方面面临艰难抉择。了解她们的治疗偏好有助于改善患者咨询服务并为药物试验提供信息。目的是通过离散选择实验调查，探索携带种系BRCA1/2基因突变的女性对各种降低风险方案的偏好，并将表达的偏好与实际行为进行比较。
设计了一项离散选择实验调查，让女性在降低乳腺癌风险的假设治疗方案中进行选择。这些假设治疗方案的特征包括乳腺癌风险降低程度、治疗持续时间、对生育能力的影响、激素水平、子宫癌风险以及给药的难易程度和方式。使用随机参数logit模型分析数据。还要求女性表达她们在手术预防和化学预防方案之间的偏好，并报告她们实际的降低风险行动。通过五个诊所的研究登记处和一个患者倡导组织招募了年龄在25至55岁之间、携带种系BRCA1/2基因突变且未患乳腺癌或卵巢癌的女性。
在2015年1月至2016年3月期间，622名女性完成了调查。降低乳腺癌风险是表达出的最重要考虑因素，其次是维持生育能力。在未来希望生育的女性子集中，维持生育能力的能力是最重要的因素，其次是风险降低程度。表示会服用化学预防药物的女性比实际服用化学预防药物的女性多得多。
携带BRCA1/2基因突变的女性对降低乳腺癌风险和维持生育能力表现出强烈偏好。目前的化学预防方案未能满足她们对有可用安全化学预防药物的表达愿望。
