Different Patterns of Risk Reducing Decisions in Affected or Unaffected BRCA Pathogenic Variant Carriers

• Published in: Cancer research and treatment Vol. 51; no. 1; pp. 280 - 288
• Main Authors: Lee, Eun-Gyeong, Kang, Hyok Jo, Lim, Myong Cheol, Park, Boyoung, Park, Soo Jin, Jung, So-Youn, Lee, Seeyoun, Kang, Han-Sung, Park, Sang-Yoon, Park, Boram, Joo, Jungnam, Han, Jai Hong, Kong, Sun-Young, Lee, Eun Sook
• Format: Journal Article
• Language: English
• Published: Korea (South) Korean Cancer Association 01.01.2019; 대한암학회
• Subjects: Adult; BRCA1 Protein - genetics; BRCA2 Protein - genetics; Breast Neoplasms - genetics; Breast Neoplasms - surgery; Breast Neoplasms, Male - genetics; Clinical Decision-Making; Female; Genetic Predisposition to Disease; Genetic Testing - economics; Humans; Male; Middle Aged; Mutation; Original; Ovarian Neoplasms - genetics; Ovarian Neoplasms - surgery; Republic of Korea; Retrospective Studies; Salpingo-oophorectomy; Watchful Waiting; 의약학; Republic of Korea; Prophylactic surgical procedure; Familial breast cancer; BRCA1; BRCA2; Ovarian neoplasms
• ISSN: 1598-2998; 2005-9256; 2005-9256
• DOI: 10.4143/crt.2018.079

The purpose of this study was to investigate decision patterns to reduce the risks of BRCArelated breast and gynecologic cancers in carriers of BRCA pathogenic variants. We found a change in risk-reducing (RR) management patterns after December 2012, when the National Health Insurance System (NHIS) of Korea began to pay for BRCA testing and riskreducing salpingo-oophorectomy (RRSO) in pathogenic-variant carriers. The study group consisted of 992 patients, including 705 with breast cancer (BC), 23 with ovarian cancer (OC), 10 with both, and 254 relatives of high-risk patients who underwent BRCA testing at the National Cancer Center of Korea from January 2008 to December 2016.We analyzed patterns of and factors in RR management. Of the 992 patients, 220 (22.2%) were carriers of BRCA pathogenic variants. About 92.3% (203/220) had a family history of BC and/or OC,which significantly differed between BRCA1 and BRCA2 carriers (p < 0.001). All 41 male carriers chose surveillance. Of the 179 female carriers, 59 of the 83 carriers (71.1%) with BC and the 39 of 79 unaffected carriers (49.4%) underwent RR management. None of the carriers affected with OC underwent RR management. Of the management types, RRSO had the highest rate (42.5%) of patient choice. The rate of RR surgery was significantly higher after 2013 than before 2013 (46.3% [74/160] vs. 31.6% [6/19], p < 0.001). RRSO was the preferred management for carriers of BRCA pathogenic variants. The most important factors in treatment choice were NHIS reimbursement and/or the severity of illness.