TBM TBM page 337 of 346 Predictors of risk-reducing surgery intentions following genetic counseling for hereditary breast and ovarian cancer Mary Kathleen Ladd, 1,2, Beth N. Peshkin, 1,2 Leigha Senter, 3 Shari Baldinger, 4 Claudine Isaacs, 1,2, Hannah Segal, 1,2 Samantha Philip, 1,2 Chloe Phillips, 1,2 Kate Shane, 3 Aimee Martin, 1,2 Veronique Weinstein, 1,2 Robert Pilarski, 3 Joanne Jeter, 3 Kevin Sweet, 3 Bonnie Hatten, 4 Elisabeth J. Wurtmann, 4 Shanda Phippen, 4 Della Bro, 4 Marc D. Schwartz 1,2 Abstract Risk-reducing mastectomy (RRM) and salpingo-oophorectomy (RRSO) are increasingly used to reduce breast and ovarian cancer risk following BRCA1/BRCA2 testing. However, little is known about how genetic counseling infuences decisions about these surgeries. Although previous studies have exam- ined intentions prior to counseling, few have examined RRM and RRSO intentions in the critical window between genetic counseling and test result disclosure. Previous research has indicated that intentions at this time point predict subsequent uptake of surgery, suggesting that much decision-making has taken place prior to result disclosure. This period may be a crit- ical time to better understand the drivers of prophylactic sur- gery intentions. The aim of this study was to examine predictors of RRM and RRSO intentions. We hypothesized that variables from the Health Belief Model would predict intentions, and we also examined the role of afective factors. Participants were 187 women, age 21–75, who received genetic counseling for hereditary breast and ovarian cancer. We utilized multiple logis- tic regression to identify independent predictors of intentions. 49.2% and 61.3% of participants reported intentions for RRM and RRSO, respectively. Variables associated with RRM inten- tions include: newly diagnosed with breast cancer (OR = 3.63, 95% CI = 1.20–11.04), perceived breast cancer risk (OR = 1.46, 95% CI = 1.17–1.81), perceived pros (OR = 1.79, 95% CI = 1.38–2.32) and cons of RRM (OR = 0.81, 95% CI = 0.65–0.996), and decision confict (OR = 0.80, 95% CI = 0.66–0.98). Variables associated with RRSO intentions include: proband status (OR = 0.28, 95% CI = 0.09–0.89), perceived pros (OR = 1.35, 95% CI = 1.11–1.63) and cons of RRSO (OR = 0.72, 95% CI = 0.59–0.89), and ambiguity aversion (OR = 0.79, 95% CI = 0.65–0.95). These data provide support for the role of genetic counseling in fostering informed decisions about risk management, and suggest that the role of uncertainty should be explored further. Keywords Hereditary breast/ovarian cancer, Intentions, Risk-reducing mastectomy, Risk-reducing oophorectomy, Genetic counseling, Decision-making INTRODUCTION Genetic testing for pathogenic variants in BRCA1 and BRCA2 (BRCA) is central to the clinical care of women at high risk for hereditary breast and ovarian cancer (HBOC) [1]. Women who carry a pathogenic variant have up to a 72% lifetime risk of developing breast cancer and up to a 44% lifetime risk of develop- ing ovarian cancer (including fallopian tube and pri- mary peritoneal cancers), compared to a 12.4% and 1.3% lifetime risk, respectively, in the general popu- lation [2, 3]. The most effective options for reducing these extremely high cancer risks are risk-reducing mastectomy (RRM) and risk-reducing bilateral sal- pingo-oophorectomy (RRSO). RRM refers to the prophylactic removal of both breasts, or in newly diagnosed patients it may entail the removal of the affected breast for treatment, and removal of the unaffected breast for risk reduction. RRSO refers to the prophylactic removal of both ovaries and fal- lopian tubes. The National Comprehensive Cancer Network (NCCN) recommends that female BRCA mutation carriers have a RRSO after they have fin- ished child bearing, and consider having a RRM [1]. RRSO reduces risk for ovarian cancer by over 80% [4] and when performed premenopausally may Implications Practice: The results provide support for the role of genetic counseling in fostering informed deci- sions about risk management, and suggest that genetic counselors could be proactive in address- ing concerns about prophylactic surgery, and facilitating appropriate follow-up and support for their patients. Policy: The important role genetic counselors play in helping to foster informed risk manage- ment decisions suggests that all at-risk women need access to a genetic counselor. Research: Research is needed to evaluate the role of ambiguity aversion and uncertainty follow- ing the receipt of genetic test results, to determine whether patients may require additional support. 1 Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC 20057 2 Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Genomics Research, Georgetown University, Washington, DC 20057 3 Division of Human Genetics, Department of Internal Medicine and Comprehensive Cancer Center, The Ohio State University, Columbus, OH 43210 4 Virgina Piper Cancer Institute, Allina Health, Minneapolis, MN 55404 ORIGINAL RESEARCH © Society of Behavioral Medicine 2018. All rights reserved. For permis- sions, please e-mail: journals.permis- sions@oup.com. Correspondence to: Marc D. Schwartz, schwartm@george- town.edu Cite this as: TBM 2020;10:337–346 doi: 10.1093/tbm/iby101 Downloaded from https://academic.oup.com/tbm/article/10/2/337/5172999 by guest on 31 December 2021