Implementation of risk-reducing surgery for HBOC under public insurance in Japan: a single-center experience
Hiroko Terui-Kohbata, Sayako Takahashi, Eriko Takamine, Mariko Komine, Maki Gau, Makiko Egawa, Yusuke Ebana, Tomoyuki Aruga, Kimio Wakana, Masayuki Yoshida
Abstract
Genes, proteins, chemicals, diseases, species, mutations and cell lines named across the full text — each resolved to its canonical identifier and authoritative record.
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TopicsMultiple and Secondary Primary Cancers · Ovarian cancer diagnosis and treatment · BRCA gene mutations in cancer
To the Editor,
In Japan, BRCA1/2 genetic testing was publicly insured in 2018, followed by risk-reducing salpingo-oophorectomy (RRSO) in 2020 and risk-reducing mastectomy (RRM) with reconstruction in 2022. These policy changes are considered to have expanded access to hereditary cancer prevention, although uptake and timing may still be influenced by clinical and personal factors. Therefore, we investigated the implementation of preventive surgery among women with hereditary breast and ovarian cancer syndrome (HBOC) at our institution under public insurance coverage.
At our institution, 23 women with HBOC underwent preventive surgery under public insurance between April 2020 and December 2024. Among them, 15 (65.2%) underwent RRM, 18 (78.3%) underwent RRSO, and 10 (43.5%) received both. Of these 23 women, 19 had been diagnosed with HBOC at our genetics department, and 10 of these 19 (52.6%) proceeded to preventive surgery.
The mean ages at RRM and RRSO were in the mid-40 s, with no significant differences between BRCA1 and BRCA2 carriers. The average interval from diagnosis to surgery was 6.5 months for RRM and 11.3 months for RRSO. Importantly, RRSO was significantly delayed among BRCA2 carriers compared with BRCA1 carriers (15.2 vs. 6.4 months, p = 0.02). The only three women who have continued to defer RRSO did so due to fertility considerations.
Before insurance coverage, only one or two RRSO procedures were performed annually, and RRM was rare because costs exceeded JPY 1,000,000, including reconstruction. Public insurance thus played a pivotal role in expanding access to both procedures [1, 2]. The observed delays among BRCA2 carriers likely reflect later ovarian cancer onset and fertility considerations [3]. These findings highlight the importance of individualized counseling that considers age, reproductive planning, and gene-specific risk, and multicenter studies are warranted to confirm whether our single-center experience reflects national trends.