Physicians' attitudes towards mammography and prophylactic surgery for hereditary breast/ovarian cancer risk and subsequently published guidelines

Abstract

After a BRCA mutation has been identified in the context of hereditary breast/ovarian cancer (HBOC), mammographic screening and prophylactic surgery are two of the main options available to those responsible for the clinical management of healthy women. The aim of this study was to describe the attitudes of specialists towards the clinical management of women with an HBOC risk: this information was collected prior to the publication of the recent French guidelines. A random national sample of 1169 French surgeons, gynaecologists and obstetricians was surveyed using a mailed questionnaire, to which 700 of these physicians (60%) responded. When dealing with a BRCA mutated woman, 88.6% of the respondents said they would recommend mammographic screening, but only 27.1% would recommend that it should be carried out annually from the age of 30 years onwards, as recommended in the French guidelines; 10.9% would find it acceptable to propose prophylactic mastectomy from the age of 30 years, and 22.9% would find it acceptable to propose prophylactic oophorectomy from the age of 35 years. The specialists who agreed with recommending breast/ovarian cancer genetic testing also had more positive attitudes towards prophylactic mastectomy (adj OR = 3.4, 95% CI = 1.4-8.2), as did those who had previously recommended prophylactic mastectomy when gene testing was not yet available (adj OR = 2.06, 95% CI = 1.23-3.44). The respondents' attitudes towards prophylactic oophorectomy and mastectomy were significantly associated (adj OR = 3.9; 95% CI = 2.3-6.5). Previous recommendation of prophylactic mastectomy was associated (P < 0.01) with a higher level of knowledge of breast/ovarian cancer genetics and with medical practice in this field. French physicians' attitudes towards mammographic screening and prophylactic surgery were not in complete agreement with the subsequently published French guidelines, the impact of which has now to be considered. Constantly evolving knowledge about the efficacy of preventive intervention will give practitioners new elements to integrate into their counselling.

Psychosocial factors and uptake of risk-reducing salpingo-oophorectomy in women at high risk for ovarian cancer

“…Such differences are likely to reflect differences in provider [31] and patient attitudes [32], which are at least in part culturally determined.…”

Prophylactic bilateral mastectomy

“…Few physicians in France recommend prophylactic bilateral mastectomy, even for BRCA1 and BRCA2 mutation carriers. 15 American physicians think more favorably of the surgery for mutation carriers. For example, 29% of obstetricians/gynecologists and 50% of the general surgeons stated that they would recommend the surgery to mutation carriers.…”

“…13,14 In France, the acceptance of prophylactic mastectomy is also very low. 15 In Canada, a follow-up study of 172 BRCA1 and BRCA2 mutation carriers is being conducted. In a preliminary analysis of the data, 10.5% (18 of 172) of the unaffected (i.e., no previous diagnosis of breast carcinoma) female mutation carriers had a bilateral prophylactic mastectomy within 3 years of receiving their genetic test result.…”

Pr�diktive Humangenetische Diagnostik bei heredit�rem Mamma- und Kolorektalkarzinom

“…Anders als in den USA, wo laut einer Studie (Meiser et al 2000) 19 % gesunder -aber mit Risiko auf hereditären Krebs -Frauen sich für eine prophylaktische Mastektomie entscheiden würden, und nur 47 % PM nicht in Erwägung ziehen würden, wird in Österreich, wie auch in anderen europäi-schen Ländern, die prophylaktische Mastektomie von gesunden Mutationsträ-gerinnen nahezu vollständig abgelehnt (Eisinger et al 2000;Koch 2001a), nur bei 25 % der bereits an Brustkrebs erkrankten Patientinnen wird die Amputation der kontralateralen Brust überhaupt in Betracht gezogen (Rutter 1999). In Studien zum psychosozialen Impact von PM (Frost et al 2000;Hatcher et al 2001) Eine Brustamputation ist ein großer chirurgischer Eingriff, der nicht ohne (signifikante) Neben-und Folgewirkungen (physische und psychische Morbidität: Narben-und Schulterschmerzen, Einschränkung der sexuellen Identität etc.)…”