Different patterns of risk reducing decisions in affected or unaffected BRCA pathogenic variant carriers

Eun Gyeong Lee, Hyok Jo Kang, Myong Cheol Lim, Boyoung Park, Soo Jin Park, So Youn Jung, Seeyoun Lee, Han Sung Kang, Sang Yoon Park, Boram Park, Jungnam Joo, Jai Hong Han, Sun Young Kong, Eun Sook Lee

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Purpose:The purpose of this study was to investigate decision patterns to reduce the risks of BRCA-related breast and gynecologic cancers in carriers of BRCA pathogenic variants. We found a change in risk-reducing (RR) management patterns after December 2012, when the National Health Insurance System (NHIS) of Korea began to pay for BRCA testing and riskreducing salpingo-oophorectomy (RRSO) in pathogenic-variant carriers. Materials and Methods: The study group consisted of 992 patients, including 705 with breast cancer (BC), 23 with ovarian cancer (OC), 10 with both, and 254 relatives of high-risk patients who underwent BRCA testing at the National Cancer Center of Korea from January 2008 to December 2016.We analyzed patterns of and factors in RR management. Results: Of the 992 patients, 220 (22.2%) were carriers of BRCA pathogenic variants. About 92.3% (203/220) had a family history of BC and/or OC, which significantly differed between BRCA1 and BRCA2 carriers (p < 0.001). All 41 male carriers chose surveillance. Of the 179 female carriers, 59 of the 83 carriers (71.1%) with BC and the 39 of 79 unaffected carriers (49.4%) underwent RR management. None of the carriers affected with OC underwent RR management. Of the management types, RRSO had the highest rate (42.5%) of patient choice. The rate of RR surgery was significantly higher after 2013 than before 2013 (46.3% [74/160] vs. 31.6% [6/19], p < 0.001). Conclusion: RRSO was the preferred management for carriers of BRCA pathogenic variants. The most important factors in treatment choice were NHIS reimbursement and/or the severity of illness.

Original languageEnglish
Pages (from-to)280-288
Number of pages9
JournalCancer Research and Treatment
Volume51
Issue number1
DOIs
StatePublished - 2019 Jan 1

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Risk Management
Ovariectomy
Ovarian Neoplasms
Breast Neoplasms
National Health Programs
Korea
Health Insurance Reimbursement
Neoplasms
Therapeutics

Keywords

  • BRCA1
  • BRCA2
  • Familial breast cancer
  • Ovarian neoplasms
  • Prophylactic surgical procedure

Cite this

Lee, Eun Gyeong ; Kang, Hyok Jo ; Lim, Myong Cheol ; Park, Boyoung ; Park, Soo Jin ; Jung, So Youn ; Lee, Seeyoun ; Kang, Han Sung ; Park, Sang Yoon ; Park, Boram ; Joo, Jungnam ; Han, Jai Hong ; Kong, Sun Young ; Lee, Eun Sook. / Different patterns of risk reducing decisions in affected or unaffected BRCA pathogenic variant carriers. In: Cancer Research and Treatment. 2019 ; Vol. 51, No. 1. pp. 280-288.
@article{00f97f87791c4c27b0b795264ea4058d,
title = "Different patterns of risk reducing decisions in affected or unaffected BRCA pathogenic variant carriers",
abstract = "Purpose:The purpose of this study was to investigate decision patterns to reduce the risks of BRCA-related breast and gynecologic cancers in carriers of BRCA pathogenic variants. We found a change in risk-reducing (RR) management patterns after December 2012, when the National Health Insurance System (NHIS) of Korea began to pay for BRCA testing and riskreducing salpingo-oophorectomy (RRSO) in pathogenic-variant carriers. Materials and Methods: The study group consisted of 992 patients, including 705 with breast cancer (BC), 23 with ovarian cancer (OC), 10 with both, and 254 relatives of high-risk patients who underwent BRCA testing at the National Cancer Center of Korea from January 2008 to December 2016.We analyzed patterns of and factors in RR management. Results: Of the 992 patients, 220 (22.2{\%}) were carriers of BRCA pathogenic variants. About 92.3{\%} (203/220) had a family history of BC and/or OC, which significantly differed between BRCA1 and BRCA2 carriers (p < 0.001). All 41 male carriers chose surveillance. Of the 179 female carriers, 59 of the 83 carriers (71.1{\%}) with BC and the 39 of 79 unaffected carriers (49.4{\%}) underwent RR management. None of the carriers affected with OC underwent RR management. Of the management types, RRSO had the highest rate (42.5{\%}) of patient choice. The rate of RR surgery was significantly higher after 2013 than before 2013 (46.3{\%} [74/160] vs. 31.6{\%} [6/19], p < 0.001). Conclusion: RRSO was the preferred management for carriers of BRCA pathogenic variants. The most important factors in treatment choice were NHIS reimbursement and/or the severity of illness.",
keywords = "BRCA1, BRCA2, Familial breast cancer, Ovarian neoplasms, Prophylactic surgical procedure",
author = "Lee, {Eun Gyeong} and Kang, {Hyok Jo} and Lim, {Myong Cheol} and Boyoung Park and Park, {Soo Jin} and Jung, {So Youn} and Seeyoun Lee and Kang, {Han Sung} and Park, {Sang Yoon} and Boram Park and Jungnam Joo and Han, {Jai Hong} and Kong, {Sun Young} and Lee, {Eun Sook}",
year = "2019",
month = "1",
day = "1",
doi = "10.4143/crt.2018.079",
language = "English",
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pages = "280--288",
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Lee, EG, Kang, HJ, Lim, MC, Park, B, Park, SJ, Jung, SY, Lee, S, Kang, HS, Park, SY, Park, B, Joo, J, Han, JH, Kong, SY & Lee, ES 2019, 'Different patterns of risk reducing decisions in affected or unaffected BRCA pathogenic variant carriers', Cancer Research and Treatment, vol. 51, no. 1, pp. 280-288. https://doi.org/10.4143/crt.2018.079

Different patterns of risk reducing decisions in affected or unaffected BRCA pathogenic variant carriers. / Lee, Eun Gyeong; Kang, Hyok Jo; Lim, Myong Cheol; Park, Boyoung; Park, Soo Jin; Jung, So Youn; Lee, Seeyoun; Kang, Han Sung; Park, Sang Yoon; Park, Boram; Joo, Jungnam; Han, Jai Hong; Kong, Sun Young; Lee, Eun Sook.

In: Cancer Research and Treatment, Vol. 51, No. 1, 01.01.2019, p. 280-288.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Different patterns of risk reducing decisions in affected or unaffected BRCA pathogenic variant carriers

AU - Lee, Eun Gyeong

AU - Kang, Hyok Jo

AU - Lim, Myong Cheol

AU - Park, Boyoung

AU - Park, Soo Jin

AU - Jung, So Youn

AU - Lee, Seeyoun

AU - Kang, Han Sung

AU - Park, Sang Yoon

AU - Park, Boram

AU - Joo, Jungnam

AU - Han, Jai Hong

AU - Kong, Sun Young

AU - Lee, Eun Sook

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose:The purpose of this study was to investigate decision patterns to reduce the risks of BRCA-related breast and gynecologic cancers in carriers of BRCA pathogenic variants. We found a change in risk-reducing (RR) management patterns after December 2012, when the National Health Insurance System (NHIS) of Korea began to pay for BRCA testing and riskreducing salpingo-oophorectomy (RRSO) in pathogenic-variant carriers. Materials and Methods: The study group consisted of 992 patients, including 705 with breast cancer (BC), 23 with ovarian cancer (OC), 10 with both, and 254 relatives of high-risk patients who underwent BRCA testing at the National Cancer Center of Korea from January 2008 to December 2016.We analyzed patterns of and factors in RR management. Results: Of the 992 patients, 220 (22.2%) were carriers of BRCA pathogenic variants. About 92.3% (203/220) had a family history of BC and/or OC, which significantly differed between BRCA1 and BRCA2 carriers (p < 0.001). All 41 male carriers chose surveillance. Of the 179 female carriers, 59 of the 83 carriers (71.1%) with BC and the 39 of 79 unaffected carriers (49.4%) underwent RR management. None of the carriers affected with OC underwent RR management. Of the management types, RRSO had the highest rate (42.5%) of patient choice. The rate of RR surgery was significantly higher after 2013 than before 2013 (46.3% [74/160] vs. 31.6% [6/19], p < 0.001). Conclusion: RRSO was the preferred management for carriers of BRCA pathogenic variants. The most important factors in treatment choice were NHIS reimbursement and/or the severity of illness.

AB - Purpose:The purpose of this study was to investigate decision patterns to reduce the risks of BRCA-related breast and gynecologic cancers in carriers of BRCA pathogenic variants. We found a change in risk-reducing (RR) management patterns after December 2012, when the National Health Insurance System (NHIS) of Korea began to pay for BRCA testing and riskreducing salpingo-oophorectomy (RRSO) in pathogenic-variant carriers. Materials and Methods: The study group consisted of 992 patients, including 705 with breast cancer (BC), 23 with ovarian cancer (OC), 10 with both, and 254 relatives of high-risk patients who underwent BRCA testing at the National Cancer Center of Korea from January 2008 to December 2016.We analyzed patterns of and factors in RR management. Results: Of the 992 patients, 220 (22.2%) were carriers of BRCA pathogenic variants. About 92.3% (203/220) had a family history of BC and/or OC, which significantly differed between BRCA1 and BRCA2 carriers (p < 0.001). All 41 male carriers chose surveillance. Of the 179 female carriers, 59 of the 83 carriers (71.1%) with BC and the 39 of 79 unaffected carriers (49.4%) underwent RR management. None of the carriers affected with OC underwent RR management. Of the management types, RRSO had the highest rate (42.5%) of patient choice. The rate of RR surgery was significantly higher after 2013 than before 2013 (46.3% [74/160] vs. 31.6% [6/19], p < 0.001). Conclusion: RRSO was the preferred management for carriers of BRCA pathogenic variants. The most important factors in treatment choice were NHIS reimbursement and/or the severity of illness.

KW - BRCA1

KW - BRCA2

KW - Familial breast cancer

KW - Ovarian neoplasms

KW - Prophylactic surgical procedure

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DO - 10.4143/crt.2018.079

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