Gootzen T A, Steenbeek M P, van Gelder M M H J, van Bommel M H D, Timmer-Bonte J N H, Kets C M, Wilke R Nitecki, Swisher E M, Norquist B M, Lu K H, Hermens R P M G, de Hullu J A
Department of Gynecology and Obstetrics, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands,.
Department of Gynecology and Obstetrics, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
Am J Obstet Gynecol. 2025 Jun 16. doi: 10.1016/j.ajog.2025.06.024.
BACKGROUND: Female BRCA1/2 pathogenic variant carriers have an increased risk of breast and ovarian cancer. In the TUBA-WISP II study, women choose between standard risk-reducing salpingo-oophorectomy or risk-reducing salpingectomy with delayed oophorectomy to prevent ovarian cancer. At inclusion, a significant proportion of the enrolled women had a history of breast cancer, which could impact decision-making. OBJECTIVE: This study aimed to describe decision-making regarding type and timing of risk-reducing surgery among women with versus without a history of breast cancer. STUDY DESIGN: Premenopausal BRCA1/2 pathogenic variant carriers completed web-based questionnaires on their personal histories and preferred risk-reducing strategy. Differences in type and timing of first risk-reducing surgery in women with versus without a history of breast cancer were assessed. A multivariable analysis was conducted to examine personal, environmental, and breast cancer related characteristics associated with the choice for risk-reducing salpingo-oophorectomy among women with a history of breast cancer. RESULTS: We included 1676 women, of whom 222 (13.2%) had a history of breast cancer. Of those, 77.0% chose RRS/DO, compared to 78.0% in the non- history of breast cancer group (p=0.73). Individuals with breast cancer before their BRCA1/2 diagnosis had their first surgery median 2 years later than women who were diagnosed simultaneously or had their BRCA1/2 diagnosis first. Women diagnosed with breast cancer within the guideline age range for completing risk-reducing salpingo-oophorectomy (35-40 BRCA1, 40-45 BRCA2) more often chose risk-reducing salpingo-oophorectomy than women before the guideline age range, odds ratio 6.2 (95%CI 1.9-19.9). CONCLUSION: A history of breast cancer was not associated with preference for a specific risk-reducing strategy. Women diagnosed with breast cancer in the guideline age range more often chose risk-reducing salpingo-oophorectomy than women diagnosed before the guideline age range.
背景:携带BRCA1/2致病变异的女性患乳腺癌和卵巢癌的风险增加。在TUBA-WISP II研究中,女性可在标准的降低风险的输卵管卵巢切除术或延迟卵巢切除术的降低风险的输卵管切除术之间进行选择,以预防卵巢癌。纳入研究时,很大一部分登记女性有乳腺癌病史,这可能会影响决策。 目的:本研究旨在描述有乳腺癌病史和无乳腺癌病史的女性在降低风险手术的类型和时机方面的决策情况。 研究设计:绝经前携带BRCA1/2致病变异的女性完成了关于其个人病史和首选降低风险策略的网络问卷。评估了有乳腺癌病史和无乳腺癌病史的女性首次降低风险手术的类型和时机差异。进行多变量分析以检查与有乳腺癌病史的女性选择降低风险的输卵管卵巢切除术相关的个人、环境和乳腺癌相关特征。 结果:我们纳入了1676名女性,其中222名(13.2%)有乳腺癌病史。其中,77.0%选择了降低风险的输卵管切除术/延迟卵巢切除术,而无乳腺癌病史组的这一比例为78.0%(p = 0.73)。在BRCA1/2诊断前患乳腺癌的个体首次手术的时间比同时诊断或先诊断BRCA1/2的女性中位数晚2年。在完成降低风险的输卵管卵巢切除术的指南年龄范围内(BRCA1为35 - 40岁,BRCA2为40 - 45岁)被诊断为乳腺癌的女性比在指南年龄范围之前的女性更常选择降低风险的输卵管卵巢切除术,比值比为6.2(95%置信区间1.9 - 19.9)。 结论:乳腺癌病史与对特定降低风险策略的偏好无关。在指南年龄范围内被诊断为乳腺癌的女性比在指南年龄范围之前被诊断的女性更常选择降低风险的输卵管卵巢切除术。
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