Satisfaction and Impact on Quality of Life of Clinical and Instrumental Surveillance and Prophylactic Surgery in BRCA-mutation Carriers

Clinical and instrumental surveillance recommendations and prophylactic breast and ovarian surgery may impact on the quality of life of patients with BRCA 1-2 mutation. A questionnaire was administered to 174 women with confirmed BRCA mutations to evaluate the satisfaction with risk-reduction strategies. Responders show a good level of satisfaction, namely a reduction of the anxiety of cancer risk. Bilateral salpingo-oophorectomy can worsen the quality of life owing to symptoms associated with early menopause. Surveillance programs are deemed useful, and the degree of satisfaction about the prophylactic surgery is generally high. Introduction: BRCA 1 and 2 mutation carriers are invited to follow intensive clinical and instrumental surveillance programs or are offered prophylactic breast and ovarian surgery. These recommendations impact many aspects of their life. This study aims to evaluate the satisfaction with surveillance and prophylactic surgery and the impact of these procedures on the quality of life. Patients and Methods: An anonymous questionnaire was administered to 174 BRCA1-2 mutation carriers. Results: A total of 95% of women comply with the scheduled checks every 6 months. Periodic examinations are considered useful for early diagnosis of breast/ovarian cancer by 91.5% of responders. Among those women who received prophylactic breast surgery, 95% believe that this procedure can reduce cancer risk, but only 65% were completely satisfied by the cosmetic outcome. Among women who underwent prophylactic ovarian surgery, 90.5% would choose it again, mainly owing to a lower degree of concern about ovarian cancer risk. The early onset of menopausal symptoms was the most frequently reported side effects, but only 21% of patients use any treatment to relieve them. Conclusion: Women who follow a surveillance program show a good level of satisfaction, thanks to the lowering of concerns of cancer risk. The degree of satisfaction about the prophylactic surgery is generally high. Risk-reducing mastectomy is usually well-accepted, despite the fact that cosmetic results are not entirely satisfactory. Bilateral salpingo-oophorectomy may impact on quality of life because of the symptoms associated with early surgical menopause, even if it can be treated with hormonal replacement therapies. (C) 2018 Elsevier Inc. All rights reserved.