Impact of breast cancer history on decision-making for ovarian cancer risk-reducing surgery in the TUBA-WISP-II study

Abstract

Background: Female BRCA1/2 pathogenic variant carriers have an increased risk of breast and ovarian cancer. In the TUBA-WISP II study, women chose between standard risk-reducing salpingo-oophorectomy and risk-reducing salpingectomy with delayed oophorectomy to prevent ovarian cancer. At inclusion, a substantial proportion of the enrolled women had a history of breast cancer, which could affect decision-making.

Objective: This study aimed to describe decision-making regarding the type and timing of risk-reducing surgery between women with and 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 the type and timing of the first risk-reducing surgery between women with and without a history of breast cancer were assessed. A multivariate analysis was performed to examine personal, environmental, and breast cancer-related characteristics associated with the choice of risk-reducing salpingo-oophorectomy among women with a history of breast cancer.

Results: This study included 1676 women, among whom 222 (13.2%) had a history of breast cancer. Of note, 77.0% of women with a history of breast cancer chose risk-reducing salpingectomy with delayed oophorectomy compared with 78.0% of women without a history of breast cancer (P=.73). Individuals with breast cancer before their BRCA1/2 diagnosis had their first surgery at a median of 2 years later than those 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 years for BRCA1 and 40-45 years for BRCA2) more often chose risk-reducing salpingo-oophorectomy than those before the guideline age range (odds ratio, 6.2 [95% confidence interval, 1.9-19.9]).

Conclusion: A history of breast cancer was not associated with a preference for a specific risk-reducing strategy. Women diagnosed with breast cancer within the guideline age range more often chose risk-reducing salpingo-oophorectomy than those diagnosed with breast cancer before the guideline age range.

Keywords: BRCA1; BRCA2; breast cancer; decision-making; ovarian cancer; prevention.