International trends in the uptake of cancer risk reduction strategies in women with a BRCA1 or BRCA2 mutation

Br J Cancer. 2019 Jul;121(1):15-21. doi: 10.1038/s41416-019-0446-1. Epub 2019 Apr 11.


Background: Women with a BRCA1 or BRCA2 mutation face high risks of breast and ovarian cancer. In the current study, we report on uptake of cancer screening and risk-reduction options in a cohort of BRCA mutation carriers from ten countries over two time periods (1995 to 2008 and 2009 to 2017).

Methods: Eligible subjects were identified from an international database of female BRCA mutation carriers and included women from 59 centres from ten countries. Subjects completed a questionnaire at the time of genetic testing, which included past use of cancer prevention options and screening tests. Biennial follow-up questionnaires were administered.

Results: Six-thousand two-hundred and twenty-three women were followed for a mean of 7.5 years. The mean age at last follow-up was 52.1 years (27-96 years) and 42.3% of the women had a prior diagnosis of breast cancer. In all, 27.8% had a prophylactic bilateral mastectomy and 64.7% had a BSO. Screening with breast MRI increased from 70% before 2009 to 81% at or after 2009. There were significant differences in uptake of all options by country.

Conclusion: For women who received genetic testing more recently, uptake of prophylactic mastectomy and breast MRI is significantly higher than those who received genetic testing more than 10 years ago. However, uptake of both BSO and breast MRI is not optimal, and interventions to increase uptake are needed.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Breast Neoplasms / diagnostic imaging
  • Breast Neoplasms / genetics
  • Breast Neoplasms / prevention & control*
  • Female
  • Genes, BRCA1*
  • Genes, BRCA2*
  • Humans
  • Magnetic Resonance Imaging
  • Mammography
  • Mastectomy
  • Middle Aged
  • Mutation*
  • Risk Reduction Behavior*
  • Salpingo-oophorectomy