Decisional conflict in women with a BRCA1 or BRCA2 pathogenic variant who have not elected for risk-reducing salpingo-oophorectomy

TL;DR

This study explores why some women with BRCA mutations remain undecided about preventive surgery, finding factors like education and having children increase decisional conflict.

Contribution

The study identifies specific predictors of decisional conflict in BRCA mutation carriers delaying risk-reducing surgery.

Findings

41% of participants had high decisional conflict scores regarding risk-reducing salpingo-oophorectomy.

Higher education, non-white race, and having children were significantly associated with higher decisional conflict.

Genetic testing more than 3 years prior was linked to lower decisional conflict.

Abstract

To identify predictors of decisional conflict among women with a BRCA pathogenic variant (PV) who were eligible for risk reducing salpingo-oophorectomy (RRSO) who had not made a decision to have surgery at least one year after receiving genetic test results.

Women with a BRCA1 or BRCA2 PV between the ages of 35 and 70 years old, who had not elected for RRSO at least 12 months after receipt of genetic test results, were administered self-report questionnaires investigating demographic variables, decisional conflict (Decisional Conflict Scale), cancer-related distress (Impact of Event Scale) and cancer risk perception. Decisional conflict scores were generated and a multivariable linear regression was conducted to identify variables associated with decisional conflict.

A sample of 107 women completed questionnaires. Overall, 44 participants (41%) had a high decisional conflict score (greater than 37.5) related to the RRSO decision. Higher education (β = 11.40, 95% C.I: 0.59, 22.20; p = 0.039), non-white race (β = 11.12, 95% C.I: 0.66, 21.57; p = 0.037), and having children (β = 22.89, 95% C.I: 10.07, 35.71; p < 0.001) were significantly associated with higher decisional conflict. Lower decisional conflict was significantly associated with genetic testing more than 3 years prior (β = -13.14, 95% C.I: -23.27, -2.99; p = 0.012).

Many women with a BRCA PV who have not elected for RRSO are experiencing high levels of decisional conflict related to the decision regarding RRSO. Interventions that target decisional conflict are needed to increase the uptake of RRSO which will result in a reduction of the risk of ovarian cancer in women with BRCA1 or BRCA2 PV.