Predictive correlates of prophylactic oophorectomy in genetically high -risk women

Women who have a breast cancer genetic mutation (BRCA) are at a significantly increased risk for the development of ovarian and breast cancer. Prophylactic oophorectomy is effective in reducing ovarian cancer risk and is recommended for genetically high-risk women. However, the demographic and health factors predictive of having preventive surgery for this condition are not known. This study was a secondary analysis of an ongoing international study examining the effect of prophylactic surgery on risk reduction and mortality from ovarian and breast cancer. The study sample included 276 women with a BRCA mutation, of whom 121 (43.84%) had a prophylactic oophorectomy, and 155 (56.16%) did not. Key variables identified by a review of the literature relating to women\u27s decision to undergo genetic testing and preventive surgery guided the study: age, Jewish ethnicity, BRCA1/2 status, family history of ovarian/breast cancer, gravidity, smoking status, and personal breast cancer history. Logistic regression analysis, controlling for study site, revealed that older age at disclosure of genetic test results, having two term pregnancies, and having a high percentage of second-degree relatives with breast cancer were predictors of prophylactic oophorectomy. Subjects from the Dana Farber Institute were also more likely to have prophylactic oophorectomy than subjects at other study sites. Cox regression analysis, controlling for study site, revealed that having both BRCA1 and BRCA2 mutations, a positive previous smoking history, older age at disclosure of genetic test results, and a high percentage of second-degree relatives with breast cancer were associated with a greater likelihood of having prophylactic oophorectomy during the time interval that women were followed. Subjects from the Dana Farber Institute, Yale University, and the University of Pennsylvania also had a greater likelihood of prophylactic oophorectomy than other study sites during the time interval of follow-up. Jewish ethnicity, personal breast cancer history, and family history of ovarian cancer were not predictors of prophylactic oophorectomy. Kaplan-Meier analysis demonstrated that Jewish ethnicity, a personal history of breast cancer, and having both BRCA1 and BRCA2 mutations were associated with a shorter time to having prophylactic oophorectomy following disclosure of genetic test results. Current smokers had a longer time to prophylactic oophorectomy than women who never smoked