Age and family history of breast cancer are the primary reasons that influence Koreans to consider genetic testing for the BRCA mutation, according to data presented at the European Society for Medical Oncology (ESMO) Asia 2016, held in Singapore.
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“Among other factors, age at diagnosis and family history are the most important,” said Dr Sung-Won Kim, Director of the Breast Care Center and CEO & President of Daerim Saint Mary’s Hospital in Seoul, Korea, who presented a Korean perspective on BRCA mutation testing.
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In a multivariate logistic regression analysis, the researchers found that participants aged ≤40 (odds ratio [OR], 3.205, 95 percent confidence interval [CI], 1.550?6.622; p=0.002) and those who had a family history of breast cancer (OR, 1.963, 95 percent CI, 1.024?3.764; p=0.042) were more likely to undergo genetic testing. [Jpn J Clin Oncol 2015;45:527-532]
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Another notable reason for the high level of participation is the decrease in cost of genetic testing after the implementation of national health insurance coverage in 2005, with only 9.6 percent (vs 61.1 percent before insurance coverage) of respondents attributing their refusal to genetic testing to financial hardship.
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Guided by the protocols of the KOHBRA* study, this retrospective analysis identified factors affecting participation of Korean families at high risk for hereditary breast and ovarian cancer (HBOC) in BRCA genetic testing. The researchers reviewed 804 individuals (647 probands and 157 family members) who underwent genetic counselling for BRCA 1/2 gene mutations at Seoul National University Bundang Hospital between July 2003 and September 2012. The acceptance rate for BRCA 1/2 mutation screening after counselling was 90.5 percent (n=728).
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The KOHBRA study was designed to determine breast cancer risk for Koreans with germline BRCA 1/2 mutation. This multicentre study, conducted by the KBCS** from 2007 through 2010 (phase I) and 2010 through 2013 (phase II), included 40 centres in South Korea, with follow-ups at 1 and 3 years.
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Additionally, a survey was conducted among 70 doctors from May through August 2016 to determine the ‘Angelina Jolie effect’ among Korean women (Jolie underwent a risk-reducing mastectomy (RRM) in 2013 and risk-reducing salpingo-oophorectomy (RRSO) in 2015). Survey results revealed that 62 participants (88.6 percent) were considering genetic counselling prior to screening in 2015, nearly double that of 2012 (n=34, 48.6 percent).
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Data provided by HIRAS*** revealed a statistically significant increase in BRCA 1/2 gene testing cases in 2015 compared with 2012 prior to the ‘Angelina Jolie effect’ (BRCA 1 [2,837 vs 946] and BRCA 2 [2,820 vs 904]). With regards to risk-reducing surgery, among BRCA carriers (unilateral cases, n=717), there were 20 and 75 patients who underwent risk-reducing contralateral mastectomy (RRCM) and RRSO, respectively, in 2015, which were five times higher than in 2012 (n=4 and 16, respectively).
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In addition to age and family history of breast cancer, the ‘Angelina Jolie effect’ has also become influential in changing the pattern of HBOC management in Korea, said Kim.
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