Manoukian Siranoush, Alfieri Sara, Bianchi Elisabetta, Peissel Bernard, Azzollini Jacopo, Borreani Claudia
Unit of Medical Genetics, Department of Medical Oncology and Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Clinical Psychlogy Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy.
Psychooncology. 2019 Sep;28(9):1871-1878. doi: 10.1002/pon.5166. Epub 2019 Jul 11.
Female carriers of BRCA1/BRCA2 mutations (BRCAm) are at increased risk of developing breast and ovarian cancer. The main prevention options currently available consist in either clinical-radiological surveillance or risk-reducing surgery. This study investigated factors that might influence the choice of risk-reducing mastectomy (RRM) and/or salpingo-oophorectomy (RRSO) over surveillance in high-risk women.
One hundred twenty-eight BRCAm women, 75 (58.60%) cancer affected (C-A) and 53 (41.40%) cancer-unaffected (C-UN), completed a baseline questionnaire concerning socio-demographic factors, personal medical history, cancer family history, and psychological dimensions. Preferences about prevention strategies were evaluated after 15 months. Multivariate logistic regression was used to analyse the relationship between these factors and the choice of RRSO or RRM in the whole cohort and the choice of surgery (RRM and/or RRSO) in C-A and C-UN women.
The analyses on the whole cohort highlighted factors associated with the choice of both RRM and RRSO ("cancer concern," "previous therapeutic mastectomy," and "number of cancer-affected family members"), but also a few specifically associated with either RRM (age) or RRSO ("health" and "energy" perception and "number of children"). Surgery was more likely to be chosen by C-A (76%) than C-UN women (34%). With the exception of "cancer concern," factors associated with the choice of surgery were different between C-A ("number of deaths for cancer in the family" and "feeling downhearted and blue") and C-UN ("number of children" and "health perception") women.
This study highlights potential drivers underlying the choice of preventive surgery, which should be considered when supporting the decision-making process in these women.
携带BRCA1/BRCA2基因突变（BRCAm）的女性患乳腺癌和卵巢癌的风险增加。目前可用的主要预防方法包括临床放射学监测或降低风险的手术。本研究调查了可能影响高危女性选择降低风险的乳房切除术（RRM）和/或输卵管卵巢切除术（RRSO）而非监测的因素。
128名携带BRCAm的女性，其中75名（58.60%）患有癌症（C-A），53名（41.40%）未患癌症（C-UN），完成了一份关于社会人口学因素、个人病史、癌症家族史和心理维度的基线问卷。15个月后评估对预防策略的偏好。采用多变量逻辑回归分析这些因素与整个队列中RRSO或RRM的选择以及C-A和C-UN女性手术（RRM和/或RRSO）选择之间的关系。
对整个队列的分析突出了与RRM和RRSO选择相关的因素（“癌症担忧”、“既往治疗性乳房切除术”和“患癌家庭成员数量”），但也有一些因素分别与RRM（年龄）或RRSO（“健康”和“精力”感知以及“子女数量”）特别相关。C-A女性（76%）比C-UN女性（34%）更有可能选择手术。除了“癌症担忧”之外，C-A女性（“家族中因癌症死亡的人数”和“情绪低落忧郁”）和C-UN女性（“子女数量”和“健康感知”）中与手术选择相关的因素有所不同。
本研究突出了预防性手术选择背后的潜在驱动因素，在支持这些女性的决策过程时应予以考虑。
