Decision-making about risk-reducing surgery for hereditary breast and ovarian cancer (HBOC) patients affected with breast cancer

Abstract

　　Application of health insurance coverage for some parts of HBOC practice accelerated our opportunity of genetic medicine in the treatment of breast cancer. We report actual decision making of risk-reducing surgery for patients with BRCA1/2 pathogenic variant. Ten patients affected with breast cancer visited our genetic counseling and considered the indication of risk-reducing surgery. Four decided to undergo both risk-reducing mastectomy (RRM) and risk reducing salpingo‒oophorectomy (RRSO), one did only RRM, and two did only RRSO. Patients preferring RRM included one with past peritoneal cancer and one during chemotherapy for bone metastases of breast cancer. In the decision-making of various breast cancer patients, especially with possible poor prognosis, we should carefully consider the indication of surgery, taking into account the balance between each disease condition and operative stress. Genetic counseling by multi-occupations and further cooperative practice of multi-department will help the determination of intent of patients.