DOCSLIB.ORG

Contralateral Prophylactic Mastectomy: an Exporatory Approach to Understanding the Decision Making Process

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Contralateral Prophylactic Mastectomy: an Exporatory Approach to Understanding the Decision Making Process CONTRALATERAL PROPHYLACTIC MASTECTOMY: AN EXPORATORY APPROACH TO UNDERSTANDING THE DECISION MAKING PROCESS A Dissertation Submitted to The Temple University Graduate Board In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY by Judith R. Greener December, 2015 Examining Committee Members: Sarah Bauerle Bass, PhD, MPH, Advisory Chair, Public Health Stephen Lepore, PhD, Public Health Adam Davey, PhD, Public Health Mary Daly, MD, PhD, Fox Chase Cancer Center © Copyright 2015 by Judith R. Greener All Rights Reserved ii ABSTRACT The rate at which women choose mastectomy has grown dramatically, and of particular note is the increase in contralateral prophylactic mastectomy (CPM). For women with no history of breast cancer or genetic risk, CPM represents a treatment decision that does not offer better long-term outcomes than the decision not to remove a healthy breast and may be associated with increased surgical risk and interventions, increased cost to the healthcare system, and potential adverse psycho-social outcomes. To better understand the decision making process regarding the election of CPM among women with early stage unilateral breast cancer, with no family history or genetic risk, a three-phase exploratory study was conducted. Qualitative in-depth interviews were conducted with healthcare providers who have close interaction with women during the decision making process (N=3) and patients who made a surgical decision about breast cancer treatment within the past three years (N=11). These two phases informed the design of the quantitative internet survey, conducted among women diagnosed with early stage breast cancer in the process of making a surgical decision (N=336). The survey design was also guided by an existing model for treatment decision making which uses a social ecological framework (Revenson & Pranikoff, 2005). In addition to descriptive analyses, perceptual mapping was utilized to understand patients’ conceptualizations of the relative importance of factors considered during the decision making process, and AdSAM® was used to gauge emotional response. Results suggest that women more likely to elect CPM demonstrate an emotional response to a generalized fear of cancer, along with the need to take control of their situation. In addition, retrospective interviews emphasized somewhat different reasons for electing CPM, highlighting the importance of prospective research in studying the decision making process. iii DEDICATION To Jim and Mariel – A world of love and appreciation. iv ACKNOWLEDGEMENTS I am indebted to the individuals who composed my committee for creating an environment that enabled me to succeed. Dr. Sarah Bass, my committee chair, provided unlimited and invaluable guidance and time, along with the unflagging support that convinced me that I actually would finish this endeavor. Dr. Stephen Lepore sparked my interest in the subject matter, and imparted the discipline required to follow this path. Dr. Adam Davey provided sound direction and advice that insured my five years of work did not turn into ten. Dr. Mary Daly guided the direction of this inquiry and I am very grateful for the time she invested. My heartfelt thanks to each one of you. A number of individuals and groups provided valued support at key junctures of this initiative. My appreciation goes out to the healthcare providers and women with breast cancer who participated in the early phases of research. Thanks to the individuals and groups who helped during the survey recruitment phase of this research, including Wes Michael, founder of Rare Patient Voice; WhatNext; Breastcancer.org; Breast Cancer Action; Life Beyond Breast Cancer; and Tomas Parsons at Temple Cancer Center, Temple University Hospital. In addition, my thanks to Dr. Jon Morris for generously allowing me to use AdSAM® and providing the AdSAM® maps. I extend appreciation to my colleagues in the program for their friendship, willingness to commiserate, and the generous way in which they shared information and advice. I am very grateful to my wonderful friends, who may not have understood why I chose to continue my education at this point in life, but still enthusiastically urged me on and kept me grounded. v Finally, it is my family who made this achievement possible. My husband Jim, through his unwavering belief that I would succeed and for making dinner every night for five years. My daughter Mariel, for inspiring me by her outlook, how she lives her life, and for making sure I knew I was ‘in it to win it’. And, my daughter Rachel, for watching over us all. vi TABLE OF CONTENTS Page ABSTRACT ....................................................................................................................... iii DEDICATION ................................................................................................................... iv ACKNOWLEDGEMENTS .................................................................................................v LIST OF TABLES ............................................................................................................ vii LIST OF FIGURES ......................................................................................................... viii CHAPTER 1. INTRODUCTION .........................................................................................................1 Overview of the Research ........................................................................................1 Purpose of the Research ..........................................................................................4 Research Questions ..................................................................................................5 Definition of Terms..................................................................................................5 Significance of the Issue for Study ........................................................................11 2. BREAST CANCER: PUTTING THE DISEASE IN CONTEXT ...............................12 Background ............................................................................................................12 Specific Considerations .........................................................................................17 Magnitude of the Disease .................................................................17 Risk Factors for the Disease .............................................................20 Socioeconomic Factors Related to Breast Cancer ............................25 Current Context ......................................................................................................28 Breast Cancer Infrastructure in the US .............................................28 vii Breast cancer Controversies ..............................................................30 Breast Cancer Screening .........................................................30 Progression of Breast Cancer Treatment ................................32 Current Literature on CPM ....................................................................................33 Outcomes Associated with CPM ......................................................33 Choosing CPM ..................................................................................34 Previous Studies Focused on CPM ...................................................37 Rationale for Research Questions ..........................................................................49 Significance of this Research .................................................................................55 3. METHODOLOGY .....................................................................................................58 Overview of Approach ...........................................................................................58 Phase 1: Qualitative Research with Healthcare Providers .....................................59 Criteria for Provider Selection ..........................................................60 Interview Structure............................................................................60 Overview of Qualitative Analysis .....................................................62 Phase 2: Qualitative Interviews with Patients ........................................................63 Theoretical Framework .....................................................................63 Criteria for Patient Selection .............................................................64 Interview Structure............................................................................66 Qualitative Analysis ..........................................................................68 Phase 3: Quantitative Research with Patients ........................................................70 Theoretical Framework .....................................................................70 Perceptual Mapping ................................................................70 viii AdSAM® ................................................................................73 Criteria for Participant Selection ......................................................76 Participant Recruiting .......................................................................76 Proposed Recruiting Plan ........................................................77 Recruiting Plan Executed ........................................................78 Interview Structure............................................................................80 Specific Measures Used
Load more

Recommended publications
  • Prophylactic Surgery Beneficial in Lynch Syndrome
    16 Gynecology O B .GYN. NEWS • March 1, 2006 Prophylactic Surgery Beneficial in Lynch Syndrome BY JEFF EVANS sociated with hereditary nonpolyposis col- from the number of women in the con- the investigators (N. Engl. J. Med. Senior Writer orectal cancer (Lynch syndrome), signifi- trol group who developed ovarian cancer 2006;354:261-9). cantly fewer endometrial cancers occurred (12 of 223). “These findings support consideration rophylactic surgery may help to pre- in women who had a prophylactic hys- The women underwent hysterectomy of prophylactic hysterectomy and bilat- vent gynecologic cancers in women terectomy (0 of 61) than in those who did or bilateral salpingo-oophorectomy at a eral salpingo-oophorectomy in women Pwith hereditary nonpolyposis col- not (69 of 210). median age of 41 years, whereas the me- with the Lynch syndrome after the age orectal cancer, reported Dr. Kathleen M. None of the 47 women who had un- dian age at diagnosis was 46 years for en- of 35, or once childbearing has been Schmeler of the University of Texas M.D. dergone a bilateral salpingo-oophorecto- dometrial cancer and 42 years for ovari- completed,” Dr. Schmeler and her col- Anderson Cancer Center, Houston, and my for cancer prevention or benign con- an cancer. leagues wrote. Only one complication her associates. ditions at the same time as their All but four of the endometrial and two (ureteral injury and repair) occurred in the In a retrospective study of a cohort of hysterectomy developed ovarian cancer, of the ovarian cancers occurred in 61 women patients who underwent pro- patients who had germ-line mutations as- but this was not significantly different women older than 35 years, according to phylactic surgery.
    [Show full text]
  • Practice Parameters for the Treatment of Patients with Dominantly Inherited Colorectal Cancer
    Practice Parameters For The Treatment Of Patients With Dominantly Inherited Colorectal Cancer Diseases of the Colon & Rectum 2003;46(8):1001-1012 Prepared by: The Standards Task Force The American Society of Colon and Rectal Surgeons James Church, MD; Clifford Simmang, MD; On Behalf of the Collaborative Group of the Americas on Inherited Colorectal Cancer and the Standards Committee of the American Society of Colon and Rectal Surgeons. The American Society of Colon and Rectal Surgeons is dedicated to assuring high quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The standards committee is composed of Society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This Committee was created in order to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus. This is accompanied by developing Clinical Practice Guidelines based on the best available evidence. These guidelines are inclusive, and not prescriptive. Their purpose is to provide information on which decisions can be made, rather than dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. Practice Parameters for the Treatment of Patients With Dominantly Inherited Colorectal Cancer Inherited colorectal cancer includes two main syndromes in which predisposition to the disease is based on a germline mutation that may be transmitted from parent to child.
    [Show full text]
  • Outcome of Triple Negative Breast Cancer: Comparison of Sporadic and BRCA1-Associated Cancers
    Breast Cancer Res Treat (2014) 146:175–182 DOI 10.1007/s10549-014-2995-6 EPIDEMIOLOGY Outcome of triple negative breast cancer: comparison of sporadic and BRCA1-associated cancers Nadine Tung • Elizabeth Gaughan • Michele R. Hacker • Larissa J. Lee • Brian Alexander • Emily Poles • Stuart J. Schnitt • Judy E. Garber Received: 5 May 2014 / Accepted: 7 May 2014 / Published online: 18 May 2014 Ó Springer Science+Business Media New York 2014 Abstract The majority of breast cancers developing in follow-up. BRCA1 carriers who underwent oophorectomy BRCA1 mutation carriers are triple negative breast cancers had a significantly lower rate of death from TNBC, with an (TNBC), an aggressive subtype that accounts for 15–20 % adjusted HR of 0.30 (95 % CI 0.10–0.94). Adjusting for of sporadic breast cancer. We compare the clinical out- age, oophorectomy, and prophylactic mastectomy, BRCA1 come and sites of relapse of TNBC in BRCA1 mutation mutation status was not an independent predictor of sur- carriers and non-carriers who received adjuvant chemo- vival (HR 2.1; P = 0.13). BRCA1 mutation carriers with therapy. Women with stage I–III TNBC who had BRCA1 TNBC had similar survival rates and sites of recurrence to testing within 36 months of diagnosis and received adju- non-carriers after treatment with conventional chemother- vant chemotherapy were identified from clinical databases apy. Carriers who underwent oophorectomy had a signifi- at two academic institutions. Sites of relapse, freedom from cantly lower rate of breast cancer-related death; this finding distant metastasis (FFDM), and breast cancer-specific sur- should be studied further in all women with TNBC.
    [Show full text]
  • Physicians' Attitudes Towards Mammography and Prophylactic
    European Journal of Human Genetics (2000) 8, 204–208 y © 2000 Macmillan Publishers Ltd All rights reserved 1018–4813/00 $15.00 www.nature.com/ejhg ARTICLE Physicians’ attitudes towards mammography and prophylactic surgery for hereditary breast/ovarian cancer risk and subsequently published guidelines Claire Julian-Reynier1, Fran¸cois Eisinger2, Jean-Paul Moatti1 and Hagay Sobol2 1INSERM U379, and 2INSERM E9939, Paoli-Calmettes Institute, Marseilles, France After a BRCA mutation has been identified in the context of hereditary breast/ovarian cancer (HBOC), mammographic screening and prophylactic surgery are two of the main options available to those responsible for the clinical management of healthy women. The aim of this study was to describe the attitudes of specialists towards the clinical management of women with an HBOC risk: this information was collected prior to the publication of the recent French guidelines. A random national sample of 1169 French surgeons, gynaecologists and obstetricians was surveyed using a mailed questionnaire, to which 700 of these physicians (60%) responded. When dealing with a BRCA mutated woman, 88.6% of the respondents said they would recommend mammographic screening, but only 27.1% would recommend that it should be carried out annually from the age of 30 years onwards, as recommended in the French guidelines; 10.9% would find it acceptable to propose prophylactic mastectomy from the age of 30 years, and 22.9% would find it acceptable to propose prophylactic oophorectomy from the age of 35 years. The specialists who agreed with recommending breast/ovarian cancer genetic testing also had more positive attitudes towards prophylactic mastectomy (adj OR = 3.4, 95% CI = 1.4–8.2), as did those who had previously recommended prophylactic mastectomy when gene testing was not yet available (adj OR = 2.06, 95% CI = 1.23–3.44).
    [Show full text]
  • Prophylactic Salpingectomy to Reduce the Risk of Cancer: Ethical Considerations
    FROM THE FIELD Prophylactic Salpingectomy to Reduce the Risk of Cancer: Ethical Considerations A Case May a salpingectomy be performed in A 28-year-old patient is 25 weeks conjunction with a C-section to reduce the pregnant with her second child. She is risk of cancer? scheduled for a C-section. She has two relatives who had ovarian cancer, one of Ministry Perspectives whom passed away from the disease. She knows that this family history increases Rev. Gerald D. Coleman, S.S., Ph.D. her risk of ovarian cancer. Vice President, Corporate Ethics Daughters of Charity Health System Ovarian cancer grows slowly. Pre-invasive Los Altos Hills, Calif. and early stage disease often go [email protected] undetected. Many patients have malignancies more than four years before Salpingectomy is a prophylactic, ovarian cancer is detected. By the time of preventative or cautionary surgery to diagnosis, the cancer is often advanced remove the fallopian tubes for women at and aggressive growth has already high risk of ovarian cancer. Between 1 in occurred. As a result, the five year survival 400 and 1 in 800 people in the U.S. rate is only about 45 percent. population carry one of the causative mutations, and salpingectomy has become At her last appointment, the patient tells the “standard of care” in these cases.1 her OB that she read that removal of the Ovarian cancer is a significant issue in fallopian tubes and the ovaries might help women’s health and the overall survival to prevent ovarian or breast cancer. The rate at five years is only about 45 percent.
    [Show full text]
  • Uptake and Timing of Bilateral Prophylactic Salpingo-Oophorectomy Among BRCA1 and BRCA2 Mutation Carriers Angela R
    March 2008 ⅐ Vol. 10 ⅐ No. 3 article Uptake and timing of bilateral prophylactic salpingo-oophorectomy among BRCA1 and BRCA2 mutation carriers Angela R. Bradbury, MD1,2, Comfort N. Ibe, BA1,2, James J. Dignam, PhD3, Shelly A. Cummings, MS1,2, Marion Verp, MD1,4, Melody A. White, MS1,2, Grazia Artioli, MD5, Laura Dudlicek, MS1,2, and Olufunmilayo I. Olopade, MD1,2 Purpose: To evaluate prophylactic salpingo-oophorectomy uptake and timing among BRCA1/2 mutation carriers in a cancer risk assessment program. Methods: Clinical records of female BRCA1/2 mutation carriers who received cancer genetic counseling between 1996 and 2003 were reviewed to determine the completion and the timing of prophylactic salpingo-oophorectomy. Logistic regression models evaluated associations between subject charac- teristics and surgery. Survival analysis methods were used to estimate the distribution of time to surgery. Results: Among 88 women, 70% underwent prophylactic salpingo-oophorectomy. Prophylactic salpingo-oophorectomy was associated with older age, white race, having children, and a family history of ovarian cancer. Many women waited more than 12 months to undergo surgery and some delayed by several years. Younger age and not having children were associated with delays to surgery. Conclusion: Prophylactic salpingo-ooporectomy is an acceptable risk reduction measure for many BRCA1/2 mutation carriers. Some women make this decision many years after genetic testing. Continued discussion of the risks and benefits of risk reduction options may facilitate
    [Show full text]
  • Prophylactic Oophorectomy Or Salpingo- Oophorectomy with Or Without Hysterectomy
    Medical Coverage Policy Effective Date ............................................. 2/15/2019 Next Review Date ....................................... 2/15/2020 Coverage Policy Number .................................. 0026 Prophylactic Oophorectomy or Salpingo- oophorectomy With or Without Hysterectomy Table of Contents Related Coverage Resources Coverage Policy ................................................... 1 Colorectal Cancer Screening and Surveillance Overview .............................................................. 2 Genetic Testing for Hereditary Cancer Susceptibility General Background ............................................ 2 Syndromes Coding/Billing Information .................................... 6 Genetic Testing for Hereditary and Multifactorial Conditions References .......................................................... 7 Prophylactic Mastectomy INSTRUCTIONS FOR USE The following Coverage Policy applies to health benefit plans administered by Cigna Companies. Certain Cigna Companies and/or lines of business only provide utilization review services to clients and do not make coverage determinations. References to standard benefit plan language and coverage determinations do not apply to those clients. Coverage Policies are intended to provide guidance in interpreting certain standard benefit plans administered by Cigna Companies. Please note, the terms of a customer’s particular benefit plan document [Group Service Agreement, Evidence of Coverage, Certificate of Coverage, Summary Plan Description (SPD)
    [Show full text]
  • The Woman with Postmenopausal Bleeding
    THEME Gynaecological malignancies The woman with postmenopausal bleeding Alison H Brand MD, FRCS(C), FRANZCOG, CGO, BACKGROUND is a certified gynaecological Postmenopausal bleeding is a common complaint from women seen in general practice. oncologist, Westmead Hospital, New South Wales. OBJECTIVE [email protected]. This article outlines a general approach to such patients and discusses the diagnostic possibilities and their edu.au management. DISCUSSION The most common cause of postmenopausal bleeding is atrophic vaginitis or endometritis. However, as 10% of women with postmenopausal bleeding will be found to have endometrial cancer, all patients must be properly assessed to rule out the diagnosis of malignancy. Most women with endometrial cancer will be diagnosed with early stage disease when the prognosis is excellent as postmenopausal bleeding is an early warning sign that leads women to seek medical advice. Postmenopausal bleeding (PMB) is defined as bleeding • cancer of the uterus, cervix, or vagina (Table 1). that occurs after 1 year of amenorrhea in a woman Endometrial or vaginal atrophy is the most common cause who is not receiving hormone therapy (HT). Women of PMB but more sinister causes of the bleeding such on continuous progesterone and oestrogen hormone as carcinoma must first be ruled out. Patients at risk for therapy can expect to have irregular vaginal bleeding, endometrial cancer are those who are obese, diabetic and/ especially for the first 6 months. This bleeding should or hypertensive, nulliparous, on exogenous oestrogens cease after 1 year. Women on oestrogen and cyclical (including tamoxifen) or those who experience late progesterone should have a regular withdrawal bleeding menopause1 (Table 2).
    [Show full text]
  • Angiogenetic and Hereditary Factors in Endometrial Disease
    From DEPARTMENT OF MEDICINE, SOLNA Karolinska Institutet, Stockholm, Sweden ANGIOGENETIC AND HEREDITARY FACTORS IN ENDOMETRIAL DISEASE Emil Andersson Stockholm 2019 All previously published papers were reproduced with permission from the publisher. Cover illustration by iStock.com/Bwiselizzy_photo Published by Karolinska Institutet. Printed by E-Print AB 2019 ©Emil Andersson, 2019 ISBN 978-91-7831-538-3 Angiogenetic and Hereditary factors in endometrial disease THESIS FOR DOCTORAL DEGREE (Ph.D.) By Emil Andersson, MD Principal Supervisor: Opponent: Associate Professor Miriam Mints Honorary Associate Professor Esther Moss Karolinska Institutet University of Leicester Department of Women’s and Childrens Health Department of Leicester Cancer Research Centre Division of Obstetrics and Gynecology Examination Board: Co-supervisor(s): Associate Professor Anna Ågren Professor Kristina Broliden Karolinska Institutet Karolinska Institutet Department of Clinical Sciences, Danderyd Department of Medicine, Solna Division of Medicine Division of Infectious Diseases Professor Richard Rosenquist Brandell Karolinska Institutet Department of Molecular Medicine and Surgery Division of Clinical Genetics Associate Professor Gisela Helenius Örebro University School of Medical Sciences To my family and friends ABSTRACT The endometrium is a unique tissue in the adult human body because it is the only site where physiological renewal of vessels, angiogenesis, occurs. The regulation of this process under normal conditions is not fully understood. Heavy Menstrual Bleeding of endometrial origin (HMB-E) and Endometrial Cancer (EC) are two diseases which can neither occur nor be sustained without the process of angiogenesis. Clinically, both diseases are also associated with a strong hereditary component where female relatives of affected patients demonstrate a high incidence of the same condition.
    [Show full text]
  • COVID-19 Experiences Predicting High Anxiety and Depression Among a Sample of BRCA1/BRCA2-Positive Women in the US
    COVID-19 Experiences Predicting High Anxiety and Depression Among a Sample of BRCA1/BRCA2-positive Women in the US Kate E Dibble ( [email protected] ) Johns Hopkins Bloomberg School of Public Health Avonne E Connor Johns Hopkins Bloomberg School of Public Health Research Article Keywords: COVID-19, BRCA1, BRCA2, anxiety, depression, disparities Posted Date: August 9th, 2021 DOI: https://doi.org/10.21203/rs.3.rs-763516/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/18 Abstract Purpose. During the COVID-19 pandemic, breast and ovarian cancer survivors experienced more anxiety and depression than before the pandemic. Studies have not investigated the similarities of this trend among BRCA1/2-positive women who are considered high risk for these cancers. The current study examines the impact of COVID-19 experiences on anxiety and depression in a sample of BRCA1/2-positive women in the U.S. Methods. 211 BRCA1/2-positive women from medically underserved backgrounds completed an online survey. Adjusted odds ratios (aORs) and 95% condence intervals (CIs) were estimated using multivariable logistic regression for associations between COVID-19 experiences and self-reported anxiety and depression stratied by demographic factors. Results. Overall, women who reported quarantining/isolation (aOR, 0.46, 95% CI, 0.24-0.88) experienced signicantly fewer depressive symptoms than women who did not report this experience. Racial/ethnic minority women caring for someone at home during COVID-19 were 3.78 times more likely (95% CI, 1.04-13.6) to report high anxiety while non-Hispanic white women were less likely (aOR, 0.36, 95% CI, 0.10-1.33, p-interaction=0.011).
    [Show full text]
  • A Discursive Analysis of Accounts of Breast Cancer Screening, Risk and Prevention
    A discursive analysis of accounts of breast cancer screening, risk and prevention Shona Crabb B.A. (Hons) School of Psychology The University of Adelaide Submitted in fulfilment of the requirements for the degree of Doctor of Philosophy November, 2006 Table of contents Abstract .................................................................................................................5 Declaration .................................................................................................................7 Publications .................................................................................................................8 Acknowledgements........................................................................................................9 Chapter 1 Introduction ..........................................................................................10 1.1 A preliminary outline......................................................................................10 1.2 An introduction to breast cancer screening, prevention and risk management....................................................................................................12 1.3 The new public health and ‘risk’ ....................................................................15 1.4 Aim of the research.........................................................................................17 1.5 Overview and structure of thesis ....................................................................19 Chapter 2 Methodological and analytic approach
    [Show full text]
  • Effectiveness of Prophylactic Surgeries in BRCA1 Or BRCA2
    Published OnlineFirst March 15, 2016; DOI: 10.1158/1078-0432.CCR-15-1465 Biology of Human Tumors Clinical Cancer Research Effectiveness of Prophylactic Surgeries in BRCA1 or BRCA2 Mutation Carriers: A Meta-analysis and Systematic Review Xiao Li1,2,RanYou3, Xinwei Wang4, Congxin Liu5, Zicheng Xu1, Jin Zhou1, Bin Yu1, Ting Xu1, Hongzhou Cai1, and Qing Zou1 Abstract Purpose: To systematically investigate the effectiveness of tralateral prophylactic mastectomy (CPM) significantly decreased prophylactic surgeries (PS) implemented in women carrying contralateral breast cancer incidence in BRCA1/2 mutation carriers BRCA1/2 mutations. (RR, 0.072; 95% CI, 0.035–0.148). Of note, PBSO was associated Experimental Design: The PubMed database was searched with significantly lower all-cause mortality in BRCA1/2 mutation till August 2014 and 15 studies met the inclusion criteria. carriers without breast cancer (HR, 0.349; 95% CI, 0.190–0.639) Fixed- or random-effects models were conducted according to and those with breast cancer (HR, 0.432; 95% CI, 0.318–0.588). study heterogeneity. We calculated the pooled relative risks In addition, all-cause mortality was significantly lower for patients (RR) for cancer risk or mortality along with 95% confidence with CPM than those without (HR, 0.512; 95% CI, 0.368–0.714). intervals (CI). However, BPM was not significantly associated with reduced all- Results: Prophylactic bilateral salpingo-oophorectomy (PBSO) cause mortality. Data were insufficient to obtain separate esti- and bilateral prophylactic mastectomy (BPM) were both associ- mates of survival benefit with PS in BRCA1 or BRCA2 mutation ated with a decreased breast cancer risk in BRCA1/2 mutation carriers.
    [Show full text]