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Behavioral and Social Science: Genetic Testing and Counseling

Predictors and outcomes of contralateral prophylactic mastectomy among breast cancer survivors.

Georgetown University, Washington, DC; University of Pennsylvania, Philadelphia, PA

Abstract

A29

Women affected with breast cancer who carry a BRCA1 or BRCA2 (BRCA1/2) mutation are at substantially increased risk of developing contralateral breast cancer. To reduce the risk of contralateral breast cancer, some patients opt for prophylactic surgery of the unaffected breast (contralateral prophylactic mastectomy; CPM) in addition to mastectomy of the affected breast. We conducted the present study to determine the predictors and outcomes of CPM in the year following BRCA1/2 genetic counseling and testing. Participants were breast cancer survivors who referred to the genetic counseling program at the Lombardi Comprehensive Cancer Center. Participants (N = 435) completed assessments prior to genetic counseling and 1, 6, and 12 months after receipt of genetic test results. Prior to testing, 16% of the sample had already undergone CPM (in conjunction with mastectomy of the affected breast). In the year following testing, 18% of those with positive test results and 3% of those with uninformative test results opted for CPM. Predictors of CPM following testing were: positive genetic test result (OR = 0.23, 95% CI = 0.08 to 0.66), younger age at cancer diagnosis (OR = .94, 95% CI = 0.88 to 1.0), and higher pre-counseling distress (OR = 3.28, 95% CI = 1.29 to 8.34). Women affected with breast cancer at a younger age, particularly those with positive test results and higher cancer-specific distress, were more likely to choose CPM than women who received uninformative test results and who were less distressed and older at diagnosis. We also compared psychosocial outcomes of those who received CPM versus those who did not. CPM did not have an adverse impact on cancer-specific or general distress in the year following genetic testing.