Prophylactic Risk‐Reducing Mastectomy (PRRM): A Set Practice or Catch‐22 Situation in LMIC. A Single‐Centre Prospective Cohort Study

Abstract

Background Pakistan's hereditary breast cancer has a higher‐than‐average prevalence. Our acceptability of prophylactic risk‐reducing mastectomy (PRRM) still needs to be determined, and genetic testing still needs to be offered to all eligible. The aim is to determine the number of women presenting to our centre who availed of PRRM after positive genetic tests and the main reasons restraining them from considering PRRM. Materials and methods This study is a single‐centre, prospective cohort. We collected data from 2017 to 2022 on BRCA1/2 and other (P/LP) gene‐positive patients. Continuous variables are presented as means (±SD) and categorical variables in percentages, with a significant P‐value of ≤ 0.05. Results Out of 477 tested individuals, only 95(20.12%) had a positive result. BRCA1/2 was positive in 70 cases, while P/LP variants were in 24 cases. Only 32.6% of eligible families underwent genetic testing, with 54.8% positivity. Altogether, 92.6% of patients had BRCA1/2‐related cancers. Only 25/95(26.3%) individuals availed of PRRM, the majority had contralateral risk‐reducing mastectomy 68% with a 20% reconstruction rate. The main reasons to decline PRRM were false belief of not having any disease 57.44%, followed by family/spouse pressure 51%, body appearance/societal perception, fear of complications/quality of life and financial constraints. Conclusion Genetic testing and its implications are still a grey area for LMICs, primarily due to the scarcity of centres offering genetic testing to eligible populations, followed by prevalent perceptions about prophylactic surgeries among the masses. Addressing relevant issues in LMICs is the need of time.