Screening Breast MRI, Chemoprevention, and Risk-Reducing Surgeries in Unaffected BRCA Carriers.

Abstract BACKGROUND: BRCA testing has identified hundreds of families with deleterious BRCA1 and BRCA2 mutations at the University of California, San Francisco (UCSF) in the last 13 years. A primary goal of identifying these high risk families is to prevent breast cancer in unaffected BRCA carriers. Enhanced screening, chemoprevention, and risk-reducing surgeries provide a spectrum of options for BRCA carriers unaffected with breast cancer.OBJECTIVE: The purpose of this research is to carefully quantitate the uptake of these interventions, and to also examine predictors for each of these interventions, in unaffected BRCA carriers.METHODS: We thoroughly surveyed all women who received BRCA counseling and testing at UCSF using the 2008 UCSF Cancer Risk Program mail-in survey. This comprehensive survey queried all BRCA testers about screening and preventive options, as well as their risk perception, cancer worry, knowledge, and opinions regarding screening and prevention. Statistical analyses were conducted to describe the unaffected BRCA+ population and their choices for screening and prevention.RESULTS: Over 80% of women (1137/1422) who received BRCA testing at UCSF in the last 13 years returned surveys. Approximately 20% of the UCSF BRCA testing population has tested positive for a known deleterious BRCA mutation. Of these, about 2/3 are affected with cancer at testing. 102 women are both unaffected with breast or ovarian cancer and BRCA+ (66 BRCA1+ and 36 BRCA2+). Their median age is 38 (mean 20-64). 29% of these unaffected carriers have undergone bilateral risk-reducing mastectomies, and 58% have undergone risk-reducing salpingo-oophrectomies. Of the women who did not undergo risk reducing mastectomies, 73% have received screening breast MRI and 7% have received chemoprevention (3.5% with tamoxifen and 3.5% with raloxifene). The following table describes differences and similarities in cancer knowledge, risk perception, and cancer worry among women who chose screening MRI, chemo-prevention, and risk reducing surgeries.Screening and Risk-Reducing Options and Their Associations Screening MRIChemopreventionRisk-Reducing Salpingo-OohprectomyRisk-Reducing MastectomyCancer Knowledge*63%63%63%63%Risk Perception†4**3.53.252.75**Cancer Worry§4445**p <0.05* Percentage correct†1 (lowest) – 5 (highest)§1 (lowest) – 12 (highest)CONCLUSIONS: Most unaffected BRCA carriers identified at UCSF have received screening breast MRI, and only 7% have received chemoprevention. At a median age of 38, nearly twice as many have undergone risk-reducing salpingo-oophrectomy (58%) compared to risk-reducing mastectomy (29%). Cancer knowledge and cancer worry do not significantly differ among women who have chosen different options. There is a significant difference in risk perception among women who have undergone screening breast MRI compared to women who have undergone risk-reducing mastectomy. We will preform phone surveys of these unaffected carriers in the next 2 months to further examine their reasons for pursuing or not pursuing each of these options. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4070.