Women's attitudes toward preventive strategies for hereditary breast or ovarian carcinoma differ from one country to another - Differences among English, French, and Canadian women

BACKGROUND. The authors investigated the acceptability to women of the prev entive strategies available for dealing with hereditary breast/ovarian carc inoma in France, the United Kingdom, and Canada, countries selected because of their cultural differences. The authors aimed to discover the existence of specific factors that may affect acceptability of these preventative me asures. METHODS. A cross-sectional, multicenter survey was conducted in Marseilles, France (n = 141), in Manchester, England (n = 130), and in Montreal, Quebe c (n = 84). All of the women attending cancer genetic clinics for the first time because of a family history of breast-ovarian carcinoma completed a s elf-administered questionnaire before their clinic consultation. RESULTS. Variations in responses to different preventative options presente d on the questionnaire were seen within the sample of patients considered a s a whole. The highest levels of acceptability were obtained for mammograph ic screening (87%) and chemoprevention (58%). In contrast, prophylactic oop horectomy and prophylactic mastectomy were thought to be acceptable at an e arly age (before 35 years), an age associated with the highest prophylactic efficacy, by only 1907o and 16% of the respondents, respectively. After mu ltivariate adjustment, the statistical data showed that the British respond ents were more in favor of oophorectomy (P < 0.0001) and more in favor of c hemoprevention than the French (P < 0.001) and the Canadian respondents (P < 0.001). The British (overall adjusted response [ORadj] = 3.9; P <less tha n> 0.001) and Canadian respondents (ORadj = 3; P < 0.01) were more in favor of prophylactic mastectomy than the French. The cumulated acceptability of mammography before the age of 40 years was found to be greater in the Fren ch (ORadj = 2.8; P < 0.01) and Canadian (ORadj = 3.1; P < 0.05) samples tha n in the British sample. CONCLUSION. These results demonstrated the existence of international varia tions in the acceptability of the preventive strategies available for women at risk for hereditary breast/ovarian carcinoma. Therefore, these results suggested that when establishing medical recommendations or planning public health interventions, physicians must integrate the population's perceptio n of advantages and drawbacks with the patient's individual decision making . (C) 2001 American Cancer Society.