Genetic testing and surgical treatment after breast cancer diagnosis: Results from a national online cohort. Issue 7 (18th March 2021)

• Record Type: Journal Article
• Authors: Verdial, Francys C.; Bartek, Matthew A.; Anderson, Benjamin O.; Javid, Sara H.
• Is Part Of: Journal of surgical oncology. Volume 123:Issue 7(2021)
• Page Start: 1504
• Page End: 1512
• Publication Date: 2021-03-18
• Subjects: BRCA -- breast cancer -- contralateral prophylactic mastectomy -- genetic risk -- genetic testing -- racial disparities; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.26372
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract: Background: Genetic testing for hereditary breast cancer has implications for breast cancer decision‐making. We examined genetic testing rates, factors associated with testing, and the relationship between genetic testing and contralateral prophylactic mastectomy (CPM). Methods: Patients with breast cancer (2000–2015) from The Health of Women Study were identified and categorized as low, moderate, or high‐likelihood of the genetic mutation using a previously published scale based on period‐relevant national guidelines incorporating age and family history. Genetic testing and CPM rates were compared using univariate and multivariate logistic regression. Results: Among 4170 patients (median age 56‐years), 38% were categorized as high‐likelihood of having a genetic mutation. Among high‐likelihood women, 67% underwent genetic testing, the odds of which were increased among women of higher‐education and White‐race ( p < .001). Among 2028 patients reporting surgical treatment, 385 (19%) chose CPM. CPM rate was highest among mutation‐positive women (41%), but 26% of women with negative tests still underwent CPM. Independent of test result, genetic testing increased the odds of CPM on multivariate analysis (adjusted‐OR: 1.69; 95% CI: 1.29–2.22). Conclusions: Genetic testing rates were higher among women at high‐likelihood of mutation carriage, but one‐third of these women were not tested. Racial disparities persisted, highlighting the need to improve testing in non‐White populations. CPM rates were associated with mutation‐carriage and genetic testing, but many women chose CPM despite negative testing, suggesting that well‐educated women consider factors other than cancer mortality in selecting CPM.