Br J Cancer. 2014 Jan 14. doi: 10.1038/bjc.2013.805. [Epub ahead of print]
Impact of rapid genetic counselling and testing on the decision to undergo immediate or delayed prophylactic mastectomy in newly diagnosed breast cancer patients: findings from a randomised controlled trial.
Wevers MR1, Aaronson NK2, Verhoef S3, Bleiker EM4, Hahn DE5, Kuenen MA2, van der Sanden-Melis J6, Brouwer T6, Hogervorst FB7, van der Luijt RB6,Valdimarsdottir HB8, van Dalen T9, Theunissen EB10, van Ooijen B11, de Roos MA12, Borgstein PJ13, Vrouenraets BC14, Vriens E15, Bouma WH16, Rijna H17,Vente JP18, Witkamp AJ19, Rutgers EJ20, Ausems MG6.
Background:Female breast cancer patients with a BRCA1/2 mutation have an increased risk of contralateral breast cancer. We investigated the effect of rapid genetic counselling and testing (RGCT) on choice of surgery.Methods:Newly diagnosed breast cancer patients with at least a 10% risk of a BRCA1/2 mutation were randomised to an intervention group (offer of RGCT) or a control group (usual care; ratio 2 : 1). Primary study outcomes were uptake of direct bilateral mastectomy (BLM) and delayed contralateral prophylactic mastectomy (CPM).Results:Between 2008 and 2010, we recruited 265 women. On the basis of intention-to-treat analyses, no significant group differences were observed in percentage of patients opting for a direct BLM (14.6% for the RGCT group vs 9.2% for the control group; odds ratio (OR) 2.31; confidence interval (CI) 0.92-5.81; P=0.08) or for a delayed CPM (4.5% for the RGCT group vs 5.7% for the control group; OR 0.89; CI 0.27-2.90; P=0.84). Per-protocol analysis indicated that patients who received DNA test results before surgery (59 out of 178 women in the RGCT group) opted for direct BLM significantly more often than patients who received usual care (22% vs 9.2%; OR 3.09, CI 1.15-8.31, P=0.03).Interpretation:Although the large majority of patients in the intervention group underwent rapid genetic counselling, only a minority received DNA test results before surgery. This may explain why offering RGCT yielded only marginally significant differences in uptake of BLM. As patients who received DNA test results before surgery were more likely to undergo BLM, we hypothesise that when DNA test results are made routinely available pre-surgery, they will have a more significant role in surgical treatment decisions.British Journal of Cancer advance online publication, 14 January 2014; doi:10.1038/bjc.2013.805 www.bjcancer.com.
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