Abstract P1-11-03: Receipt of Risk Reduction strategies among an underserved population of BRCA mutation carriers
Authors: Thekkekara Romy , Seelaus Christina , O"Connell Maria , Marcus Elizabeth , Ganschow Pamela S 
Published: May 2015

Introduction: Risk reduction strategies for women with deleterious BRCA mutations include risk-reducing mastectomy (RRM) or screening with annual mammograms and MRIs, chemoprevention and prophylactic bilateral salpingo-oophorectomy (RRBSO). The objective of the study was to describe the receipt of various risk reduction strategies in an underserved and largely understudied minority population of BRCA mutation carriers.

Methods: Positive BRCA mutation carriers detected in our center between October 2005 and January 2014 were included in the study. Participants who had bilateral mastectomies prior to genetic testing were excluded from the analysis of breast cancer reduction strategies. Women age 40 or older, with at least one ovary intact at baseline and no history of ovarian malignancy or metastatic cancer were included in the analysis of uptake of RRBSO. Compliance with annual screening mammogram and MRI was defined as receipt of 2 screening mammograms and 2 MRIs within 2 years of the disclosure of the test results. Medical records were reviewed to collect demographic data, personal history of cancer and receipt of mammography, MRI, RRM and RRBSO.

Results: Of the 87 BRCA mutation carriers, 84 were women and 3 were men. 35% were Caucasian, 31% were African American and 26% were Hispanic. Seventy percent were uninsured and 24% had public insurance. The mean age at the time of testing was 44 years (range: 18-71 years). BRCA1 positivity was seen in 54% and BRCA2 positivity was seen in 46%. Of the 84 total women, 6 had bilateral mastectomies prior to testing and 11 were lost to follow up. Of the remaining 67 women, 53 (79%) had a personal history of breast and/or ovarian cancer (affected) and 14 (21%) had no personal history of breast or ovarian cancer (unaffected). Among the 53 affected women, 14 (26%) received RRMs. The median duration from disclosure to RRM was 91.5 days (IQR: 22- 442 days). Among the 39 affected that did not undergo RRM, 31 had follow up care at our institution for at least 2 years after disclosure, during which 25 (81%) had at least 2 screening mammograms and 13 (42%) had at least 2 screening MRIs. Among the 14 unaffected women, 0 women underwent RRM (0%). Eleven unaffected women had follow up care at our institution for at least 2 years after testing, during which 5 (45%) had at least 2 mammograms and 3 (27%) had at least 2 MRIs. Of the 40 women eligible for RRBSO, 5 (13%) women were lost to follow up. Among the 35 remaining, 22 (63%) underwent RRBSO. Twenty-one out of the 22 who underwent RRBSO had a previous history of cancer. The median duration between disclosure to RRBSO was 167 days (IQR: 88-448 days). Thirteen women (37%) have not yet received the recommended RRBSO after a median follow up of 976 days (IQR:465-1591 days).

Conclusions:Among a diverse group of medically underserved minority women who tested positive for a deleterious BRCA mutation, the receipt of surgical risk reduction strategies and MRI screening is low, especially among women who do not have a personal history of cancer. Additional studies are needed in this population to examine the factors associated with acceptability and compliance with standard of care recommendations as well as institutional barriers to receipt of these risk reduction strategies.

Citation Format: Romy Thekkekara, Christina Seelaus, Maria O"Connell, Elizabeth Marcus, Pamela S Ganschow. Receipt of Risk Reduction strategies among an underserved population of BRCA mutation carriers [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-11-03.