Effects of False-Positive Cancer Screenings and Cancer Worry on Risk-Reducing Surgery Among BRCA1/2 Carriers.

Document Type

Article

Publication Date

7-2015

Institution/Department

Maine Medical Center Research Institute; Center for Outcomes Research and Evaluation

Journal Title

Health Psychology

MeSH Headings

Genes, BRCA; Health Screening Psychosocial Factors; Breast Neoplasms Diagnosis; False Positive Results Psychosocial Factors; Women's Health; Early Detection of Cancer; Psychosocial Aspects of Illness; Mutation; Breast Neoplasms Surgery; Attitude to Illness; Human; Female; Adult; Middle Age; Brief Symptom Inventory; Scales; Confidence Intervals; Odds Ratio; Sensitivity and Specificity; P-Value; Attitude to Risk; Adult: 19-44 years; Middle Aged: 45-64 years; Female

Abstract

Objective: Female BRCA1/2 mutation carriers are at increased risk of breast and ovarian cancer. Annual breast and semiannual ovarian cancer screening is recommended for early detection, which frequently leads to false-positive test results (FPTR). FPTR may influence cancer risk perceptions and worry, which in turn may affect an individual's decision to undergo risk-reducing bilateral salpingo-oophorectomy (RRSO) or risk-reducing bilateral mastectomy (RRBM). The purpose of this study was to examine: (a) the effect of false-positive breast and ovarian cancer screening test results on perceived cancer risk and cancer worry, and (b) the joint effects of FPTR, risk perceptions, and worry on the choice of risk-reducing surgery among BRCA1/2 mutation carriers undergoing an intensive cancer screening protocol. Method: BRCA1/2 mutation carriers (N = 170) reported cancer risk perceptions and cancer worry during a prospective 4-year screening protocol (2001-2007) at the U.S. National Cancer Institute. FPTR and risk-reducing surgeries were objectively recorded. Results: FPTR at baseline were associated with transient elevations in worry; cumulative FPTR across the entire study were not associated with opting for risk-reducing surgery. However, cancer-specific worry was a strong predictor of surgery (RRSO: OR = 6.15; RRBM: OR = 4.27). Conclusions: In women at inherited risk of breast and ovarian cancer, FPTR were not associated with large increases in cancer risk perception, cancer worry, or increased uptake of risk-reducing surgery. However, cancer-specific worry was an independent predictor of uptake of risk-reducing surgery and warrants consideration when counseling high-risk women regarding risk-reducing interventions.

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