Impact of breast cancer history on decision-making for ovarian cancer risk-reducing surgery in the TUBA-WISP-II study.

BACKGROUND Female BRCA1/2 pathogenic variant carriers have an increased risk of breast and ovarian cancer. In the TUBA-WISP II study, women choose between standard risk-reducing salpingo-oophorectomy or risk-reducing salpingectomy with delayed oophorectomy to prevent ovarian cancer. At inclusion, a significant proportion of the enrolled women had a history of breast cancer, which could impact decision-making. OBJECTIVE This study aimed to describe decision-making regarding type and timing of risk-reducing surgery among women with versus without a history of breast cancer. STUDY DESIGN Premenopausal BRCA1/2 pathogenic variant carriers completed web-based questionnaires on their personal histories and preferred risk-reducing strategy. Differences in type and timing of first risk-reducing surgery in women with versus without a history of breast cancer were assessed. A multivariable analysis was conducted to examine personal, environmental, and breast cancer related characteristics associated with the choice for risk-reducing salpingo-oophorectomy among women with a history of breast cancer. RESULTS We included 1676 women, of whom 222 (13.2%) had a history of breast cancer. Of those, 77.0% chose RRS/DO, compared to 78.0% in the non- history of breast cancer group (p=0.73). Individuals with breast cancer before their BRCA1/2 diagnosis had their first surgery median 2 years later than women who were diagnosed simultaneously or had their BRCA1/2 diagnosis first. Women diagnosed with breast cancer within the guideline age range for completing risk-reducing salpingo-oophorectomy (35-40 BRCA1, 40-45 BRCA2) more often chose risk-reducing salpingo-oophorectomy than women before the guideline age range, odds ratio 6.2 (95%CI 1.9-19.9). CONCLUSION A history of breast cancer was not associated with preference for a specific risk-reducing strategy. Women diagnosed with breast cancer in the guideline age range more often chose risk-reducing salpingo-oophorectomy than women diagnosed before the guideline age range.