IF YOU WERE A BRCA MUTATION CARRIER WHAT WOULD YOU DO? FACTORS PREDICTING THE CHOICE OF PROPHYLACTIC OVARIECTOMY IN A SAMPLE OF ITALIAN WOMEN

Purpose: Prophylactic removal of ovaries in women with BRCA mutations is the only option that significantly reduces their risk of developing ovarian cancer. The aim of this study was to assess attitudes toward ovarian cancer risk management options in a sample of Italian healthy women, and to identify predictors of the preference for prophylactic surgery, in order to inform genetic counselling sessions. 

Method(s): One hundred eighty-one women aged between 30 and 45 were randomly presented with material about BRCA1 or BRCA2 after stratifying for Having children or not and Age group, and completed a questionnaire, which included questions about preferences, knowledge, risk perception, and socio-demographic information. Choice was analysed using binary logistic regression models and with a model selection approach. First, all predictor variables were included in the model, and then the model was progressively reduced, until the plausibility of the model was no longer increased by removing variables.

Result(s): Results show that intensified surveillance was the preferred option (64.6%), followed by surgery (24.3%). Seven predictors of choice were included in the model: knowing that life expectancy is longer with surgery, perceived comprehension of all the consequences of testing, previous knowledge about BRCA testing, anticipated worry about developing cancer, feelings of risk (all associated with a higher likelihood to prefer surgery over intensified surveillance), having childbearing intentions, and the extent to which childbearing intentions affected choice (both associated with a lower likelihood to prefer surgery).

Conclusion(s): Our study provides useful indications for genetic counsellors in order to promote informed uptake of preventive removal of ovaries in the context of BRCA mutation. Based on our findings, we suggest that: a) during counselling, when describing the available options, the comparative effectiveness of surgery and surveillance and their effect on life expectancy should be made clear; b) counsellors should ensure that patients correctly feel they understood all the consequences of their decision; c) since previous knowledge on BRCA testing is beneficial, information provision prior to counselling may be useful; d) affective-based risk perception drives preference for prophylactic surgery more than cognitive-based risk perception, although risk communication is an essential component of genetic counselling; e) in addition to discussing childbearing intentions, also the effect of childbearing intentions on choice should be considered.