Prophylactic surgery decisions and surveillance practices one year following BRCA1/2 testing

Prev Med. 2000 Jul;31(1):75-80. doi: 10.1006/pmed.2000.0684.


Background: Although genetic testing for breast cancer risk is clinically available, its impact on health-related behaviors is unknown. This study examined prophylactic surgery and surveillance behavior during the year following BRCA1/2 gene testing.

Methods: Participants were female members (n = 216) of hereditary breast-ovarian cancer families (84 mutation carriers, 83 noncarriers and 49 test decliners). In this prospective observational study, utilization of prophylactic surgery and surveillance behavior were assessed 1-year following BRCA1/2 testing.

Results: Only 3% of the unaffected carriers obtained prophylactic mastectomy during the 1-year follow-up period. Among the remaining females, carriers had significantly higher rates of mammography (68%) than noncarriers (44%); (OR = 7.1; C.I. = 1.36-37.1; P = 0.02). However, the adherence rate in carriers was unchanged from baseline, suggesting that this difference is attributable to a reduction in screening among noncarriers. Women ages 25-39 years were significantly less likely to obtain mammograms than those aged 40 years and older. Cancer-related distress had a positive but nonsignificant (P < 0.07) association with adherence in bivariate but not multivariate analysis. With regard to ovarian risk, only 13% of carriers obtained prophylactic oophorectomy; of the remaining female carriers, only 21% reported a CA125 and 15% reported a transvaginal ultrasound.

Conclusion: The vast majority of BRCA1/2 carriers may not opt for prophylactic surgery, and many do not adhere to surveillance recommendations. Greater attention to risk communication and medical decision-making is warranted.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Attitude to Health*
  • Breast Neoplasms / genetics*
  • Breast Neoplasms / prevention & control
  • Breast Neoplasms / surgery*
  • Confidence Intervals
  • Female
  • Follow-Up Studies
  • Genes, BRCA1 / genetics*
  • Genetic Testing / methods
  • Genetic Testing / psychology
  • Heterozygote
  • Humans
  • Logistic Models
  • Mastectomy / statistics & numerical data*
  • Middle Aged
  • Odds Ratio
  • Ovarian Neoplasms / genetics*
  • Ovarian Neoplasms / prevention & control
  • Ovarian Neoplasms / surgery*
  • Ovariectomy / statistics & numerical data*
  • Population Surveillance
  • Primary Prevention*
  • Probability
  • Prospective Studies