Abstract PS7-70: Uptake of screening and risk reducing recommendations among women with hereditary breast and ovarian cancer syndrome evaluated at a large urban comprehensive cancer center
Authors: Levitin Maria , Assad Hadeel , Jang Hyejeong , Chen Wei , Petrucelli Nancie , Simon Michael 
Published: February 2021

Background: Carriers of pathogenic variants in BRCA1 and BRCA2 have an elevated lifetime risk of breast, ovarian and other cancers. Current NCCN guidelines recommend specific screening for early cancer detection and risk reducing surgeries. Previous studies investigating the choices women make following the identification of pathogenic germline BRCA1 or BRCA2 variants reveal racial disparities in uptake of recommendations with black patients having lower rates of risk-reducing surgical procedures. We report on screening and prevention practices among 128 women identified with a pathogenic BRCA1 or BRCA2 variant at a large, urban comprehensive cancer center in Detroit, Michigan to evaluate racial differences in compliance with screening and prevention practices and to identify potential barriers to guideline-recommended care.

Methods: The study population included women evaluated for genetic counseling and testing at the Karmanos Cancer Institute (KCI) from January 1, 2000 through December 31, 2017, who tested positive for a pathogenic variant in BRCA1 or BRCA2. A 54-item mail or telephone-based questionnaire was used to measure sociodemographics, medical history, cancer screening and risk reducing surgery, and cancer worries and fears. The primary and secondary outcomes were rate of risk reducing salpingo-oophorectomy (RRSO) and risk reducing mastectomy (RRM). Univariable logistic regression analyses were performed to identify potential predictors of RRSO and RRM, including race, personal cancer history, age at survey, time interval since BRCA1 or BRCA2 diagnosis, education, income, marital status and family history of a pathologic BRCA variant. P values less than 0.05 were considered statistically significant.

Results: Of 374 women with pathogenic BRCA1 or BRCA2 variants during the study period, 129 (35%) completed the study survey (75 written, 54 telephone) with one ineligible. Of the 128 BRCA1 or BRCA2 carriers, 94 (73%) and 76 (59%) underwent RRSO and RRM, respectively and 13 (38%) and 10 (19%) planned to complete those procedures in the future. The rate of RRSO was 72% for white and 71% for black carriers. Black women tended to be less likely to have RRM compared to white women, but this difference did not reach statistical significance (OR 0.5 [95% CI 0.17 - 1.43], p = 0.193). Women who had RRM were 3 times more likely to have RRSO (and vice versa) (OR = 3.28, p = 0.004). With each increasing year of age at the time of genetic counseling, the odds of RRSO increased by 6% (OR = 1.06, p = &lt;0.001). The odds of having had RRM increased with the time interval between genetic diagnosis and the survey by 9% (OR = 1.09, p = 0.043) for each elapsed year. The occurrence of new breast or ovarian cancer since genetic testing had no impact on RRSO, however participants who developed a new ovarian cancer had higher odds of having RRM (OR = 2.63, p = 0.01). There was no association between rate of RRSO or RRM with education level, annual household income, marital status or family history of pathologic BRCA variant.

Conclusion: There was no racial difference in the rate of RRSO or RRM between white and black carriers of pathogenic BRCA1 or BRCA2 variants. Further multivariable models will assess predictors of risk reducing surgeries and will include assessment of screening practices as well as cancer worries and fears.

Citation Format: Maria Levitin, Hadeel Assad, Hyejeong Jang, Wei Chen, Nancie Petrucelli, Michael Simon. Uptake of screening and risk reducing recommendations among women with hereditary breast and ovarian cancer syndrome evaluated at a large urban comprehensive cancer center [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-70.