Barriers to hormone therapy following prophylactic bilateral salpingo-oophorectomy in BRCA1/2 mutation carriers

Jessica B. DiSilvestro, From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI.
Jessica Haddad, From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI.
Katina Robison, From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI.
Lindsey Beffa, From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI.
Jessica Laprise, From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI.
Jennifer Scalia-Wilbur, From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI.
Christina Raker, From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI.
Melissa Clark, From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI.
Elizabeth Lokich, From the Department of Obstetrics-Gynecology, Program in Women's Oncology, Brown University/Women and Infants Hospital, Providence, RI.
Erin Hofstatter, Cancer Genetics and Prevention Program, Yale Cancer Center, Yale School of Medicine, New Haven, CT.
Disha Dalela, Cancer Genetics and Prevention Program, Yale Cancer Center, Yale School of Medicine, New Haven, CT.
Leslie Bradford MD, Maine Medical CenterFollow
Maris Toland, Maine Medical Center

Document Type

Article

Publication Date

5-16-2023

Institution/Department

Obstetrics & Gynecology; Oncology

Journal Title

Menopause (New York, N.Y.)

Abstract

OBJECTIVE: This study aimed to identify barriers to hormone therapy (HT) use among women with BRCA1/2 mutations after prophylactic bilateral salpingo-oophorectomy (BSO). METHODS: A cross-sectional, electronic survey was conducted of BRCA1/2 mutation carriers at Women and Infants Hospital, Yale Medical Center, Hartford Healthcare, and Maine Medical Center. This study was a subanalysis of a subset of female BRCA1/2 mutation carriers who had undergone a prophylactic BSO. Data were analyzed using the Fisher's exact test or t test. RESULTS: We performed a subanalysis of 60 BRCA mutation carriers who underwent a prophylactic BSO. Only 24 women (40%) reported ever using HT. HT use was higher in women who underwent their prophylactic BSO at age younger than 45 years (51% vs. 25%, P = 0.06). Among all women who had a prophylactic BSO, the majority (73%) reported that a provider talked to them about using HT. Two thirds reported having seen contradictory information in the media about long-term consequences of HT. Seventy percent listed their provider as the primary influence in their decision to start HT. The most common reasons for not starting HT included it not being recommended by their physician (46%) and that it was not necessary (37%). CONCLUSIONS: BRCA mutation carriers frequently undergo prophylactic BSO at young ages, and less than half report using HT. This study highlights barriers to HT use, such as patient fears and physician discouragement, and identifies potential areas to improve educational efforts.

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