Abstract P6-09-05: Factors associated with the uptake of risk-reducing surgeries among Hispanic women at high risk of breast and ovarian cancer
Authors: Chavarri-Guerra Y , Yang K , Komenaka I , Brown S , Del Toro Valero A , Mora Alférez P , Duncan P , Rodríguez Y , Ganschow P , Campbell-Fontaine A , Unzeitig G , Horcasitas D , Feldman NR , Slavin T , Nehoray B , Guerrero-Llamas N , Mejia R , Sand S , Blazer K , Weitzel J 
Published: February 2018

Abstract
Background: BRCA mutation carriers have an increased lifetime risk of breast and ovarian cancer. Although risk-reducing surgeries have documented utility, social factors, cultural beliefs and access to healthcare may be barriers among the Hispanic population to the uptake of risk-reducing practices. We aimed to describe the uptake of risk-reducing mastectomy (RRM) and risk-reducing salpingo-oophorectomy (RRSO) among Hispanic women referred for genetic cancer risk assessment (GCRA) and to identify factors affecting that uptake.
Methods: Hispanic women from the US and Latin America (LatAm) (Mexico, Colombia, Peru and Puerto Rico) referred for GCRA and enrolled in the Clinical Cancer Genomics Community Research Network (CCGCRN) registry from 1997 to 2016 were included. Demographic characteristics and data regarding risk-reducing surgeries were obtained from chart reviews and patient reported follow-up questionnaires. Data was analyzed using Fisher's test and x2 statistics with a two-sided p value of &lt;0.05 considered significant. An adjusted logistic regression model including a set of significant factors was constructed in order to predict the likelihood of undergoing risk-reducing surgery.
Results: Information about risk-reducing surgery status was collected on 1,784 Hispanic women referred for GCRA. Median age was 44.6 years (range 19-98), 84% (n=1506) had a personal history of any type of cancer and 18% (n=323) were BRCA carriers. Median follow-up was 2.6 years. 389 (22%) women had RRM, 167 (17%) had RRSO and 64 (4%) had both surgeries. RRM and RRSO occurred 32 days (SD 983.8) and 228 days (SD 1050.9) after GCRA, respectively. Among BRCA carriers, the rates of RRM and RRSO were 39.42% (n = 123) and 42.66% (n = 93), respectively. The frequency of RRM and RRSO among Hispanic BRCA carriers living in the US was higher than among those living in LatAm (53 vs. 29%, p &lt; 0.01) and (67 vs 21.5%, p &lt; 0.01), respectively. On multivariate analysis, the following factors were associated with a higher likelihood of undergoing RRM: BRCA positive status (HR 5.4, p&lt; 0.01), personal history of breast cancer (HR 6.05, p &lt; 0.01), living in the US (HR 6.53, p&lt; 0.01) and one or more previous pregnancies (HR 1.42, p&lt; 0.01). Educational level, marital status and age were not associated with a likelihood of undergoing RRM. BRCA positive status (HR 12.41, p&lt; 0.01), living in the US (HR 4.23, p&lt;0.01) and age &gt;45 years (HR 2.41, p&lt;0.01) were associated with a higher likelihood of RRSO. Educational level, marital status and family history of cancer were not associated with a higher likelihood of undergoing RRSO.
Conclusions: Our results suggest that the rate of RRM and RRSO among Hispanic women is lower than those reported in previous studies in other populations. Hispanic women living in US, BRCA carriers, and women with a personal history of cancer were more likely to have risk-reducing surgeries, which may be a reflection of disparities in access to care between countries and fragmented health systems, as well as of knowledge and cultural barriers. New strategies are warranted in order to improve the uptake of risk-reducing strategies among Hispanic women at an increased risk of cancer.
Citation Format: Chavarri-Guerra Y, Yang K, Komenaka I, Brown S, Del Toro Valero A, Mora Alférez P, Duncan P, Rodríguez Y, Ganschow P, Campbell-Fontaine A, Unzeitig G, Horcasitas D, Feldman NR, Slavin T, Nehoray B, Guerrero-Llamas N, Mejia R, Sand S, Blazer K, Weitzel J. Factors associated with the uptake of risk-reducing surgeries among Hispanic women at high risk of breast and ovarian cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-09-05.