Different Patterns of Risk Reducing Decisions in Affected or Unaffected BRCA Pathogenic Variant Carriers.
- Author:
Eun Gyeong LEE
1
;
Hyok Jo KANG
;
Myong Cheol LIM
;
Boyoung PARK
;
Soo Jin PARK
;
So Youn JUNG
;
Seeyoun LEE
;
Han Sung KANG
;
Sang Yoon PARK
;
Boram PARK
;
Jungnam JOO
;
Jai Hong HAN
;
Sun Young KONG
;
Eun Sook LEE
Author Information
- Publication Type:Original Article
- Keywords: BRCA1; KW -; BRCA2; Familial breast cancer; Ovarian neoplasms; Prophylactic surgical procedure
- MeSH: Breast; Breast Neoplasms; Female; Humans; Korea; Male; National Health Programs; Ovarian Neoplasms; Prophylactic Surgical Procedures
- From:Cancer Research and Treatment 2019;51(1):280-288
- CountryRepublic of Korea
- Language:English
- Abstract: PURPOSE: 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. MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSION: 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.
