COMPARING YOUNG AND OLDER ITALIAN WOMEN ON PREFERENCES FOR BRCA TESTING AND RISK REDUCTION AND MANAGEMENT STRATEGIES

Purpose:   When turning 18, women are legally allowed to undergo BRCA1/2 mutation testing, long before risk management and reducing options are available and recommended (usually starting at 30). The aim of this study was to compare risk perceptions and intentions towards predictive testing in two cohorts of Italian Healthy women: a group of young women (18-24 years) and a group of older women (30-45 years). 

Method(s):   Three hundred and two women, aged between 18 and 24 and between 30 and 45, were randomly presented with material about BRCA1 or BRCA2 predictive testing. Then, they completed a questionnaire measuring: intentions to undergo predictive testing, decisional conflict about testing, preferences for risk management and risk reduction options, perceived comprehension and knowledge of the information material, risk knowledge and risk perception, as well as socio-demographic information. The two age groups were compared on these dependent variables using ANOVAs for continuous variables and logistic regression for categorical variables.

Result(s):   Results show that the two groups did not differ in intention to undergo predictive testing, nor in their self-reported measures of decisional conflict about the choice to undergo testing. However, younger women showed lower perceived comprehension of the consequences of testing, lower knowledge scores, and lower recall of risk information, compared to older women. Additionally, younger women reported lower perceived likelihood of developing ovarian cancer than older women, and they would opt for preventive surgery of the ovaries less frequently than older women. Also, pharmacological options were more frequently preferred by younger than by older women.

Conclusion(s):    Our results question whether younger women are ready for predictive testing. Indeed, while having adequate knowledge is essential to informed decision making, younger women had difficulties in properly understanding consequences of testing, as shown by both subjective and objective measures. The lower preference for preventive surgical removal of ovaries (recommended option) supports that younger women are less prepared to make an informed decision. We recommend that during individual counselling, special attention should be paid to younger women to ensure that they properly appraise all the consequences of predictive testing before deciding whether to undergo it, including their decision in terms of the risk management options available after testing positive. Costs and benefits regarding the decision to postpone testing should also be carefully considered.