Intention to undergo prophylactic bilateral mastectomy in women at increased risk of developing hereditary breast cancer

Purpose: To assess intention to undergo prophylactic bilateral mastectomy a nd psychologic determinants in unaffected women at increased risk of develo ping hereditary breast cancer. Patients and Methods: Three hundred thirty-three women who were awaiting th eir initial appointments for risk assessment, advice about surveillance, an d prophylactic options at one of 14 familial cancer clinics participated in a cross-sectional, questionnaire-based survey. Results: Nineteen percent of women would consider and 47% would not conside r a prophylactic mastectomy, should genetic testing identify a mutation in a breast cancer-predisposing gene, whereas 34% were unsure and 1% had alrea dy undergone a prophylactic mastectomy. In a bivariate analysis, women at a moderately increased risk of developing breast cancer had the highest prop ortion of subjects reporting that they would consider a prophylactic mastec tomy (25%), compared with women at high risk (16%) (chi(2) = 7.79; P = .051 ). In multivariate analyses, consideration of prophylactic mastectomy stron gly correlated with high levels of breast cancer anxiety (odds ratio [OR] = 17.4; 95% confidence interval [CI], 4.35 to 69.71; P = .0001) and overesti mation of one's breast cancer risk (OR = 3.01; 95% CI, 1.43 to 6.32; P = .0 036), whereas there was no association with objective breast cancer risk (P = .60). Conclusion: A significant proportion of women at increased risk of developi ng hereditary breast cancer would consider prophylactic mastectomy. Althoug h prophylactic mastectomy may be appropriate in women at high risk of devel oping breast cancer, it is perhaps less so in those who have a moderately i ncreased risk. Such moderate-risk women are likely to benefit from interven tions aimed at reducing breast cancer anxiety and correcting exaggerated br east cancer risk perceptions. J Clin Oncol 18:2250-2257. (C) 2000 by Americ an Society of Clinical Oncology.