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Testing for Hereditary Breast and Ovarian Cancer in the Southeastern United States

Miron, Alexander PhD*∥; Schildkraut, Joellen M. PhD; Rimer, Barbara K. DrPH§; Winer, Eric P. MD; Sugg Skinner, Celette PhD; Futreal, P. Andrew PhD*; Culler, Duane PhD; Calingaert, Brian MS; Clark, Shelly MS; Kelly Marcom, P. MD; Iglehart, J. Dirk MD*∥

Scientific Papers
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Objectives To detail characterization of mutations and uncharacterized variants in the breast cancer susceptibility genes BRCA1 and BRCA2, as observed in a population of breast cancer patients from the southeastern United States, and to examine baseline characteristics of women referred for counseling and testing and provide a preliminary look at how counseling and testing affected intentions toward prophylactic surgery.

Background Mutations in the BRCA1 and BRCA2 genes give rise to a dramatically increased risk of developing breast or ovarian cancer or both. There are many reports about special populations in which deleterious mutations are present at a high frequency. It is useful to study these genes in more heterogeneous populations, reflecting different geographic regions. Interest in preventive surgery for gene carriers is high in women and their surgeons.

Methods Women were recruited through a prospective clinical trial of counseling and free genetic testing. BRCA1 and BRCA2 were screened for mutations using standard techniques, and results were given to participants. Baseline questionnaires determined interest in preventive surgery at the beginning of the study. Follow-up questionnaires for those who completed testing surveyed interest in prophylactic surgery after counseling and receiving test results.

Results Of 213 women who completed counseling and testing, 44 (20.6%) had 29 separate mutations; there were 11 Jewish women carrying three founder mutations. Twenty-eight women (13.1%) had uncharacterized variants in BRCA1 or BRCA2; nine were not previously reported. Women overestimated their chances of possessing a deleterious gene mutation compared to a statistical estimate of carrier risk. A number of women changed their intentions toward preventive surgery after genetic counseling and testing.

Conclusions Hereditary breast cancer due to mutations in BRCA1 and BRCA2 was a heterogeneous syndrome in the southeastern United States. Most mutations were seen just once, and uncharacterized variants were common and of uncertain clinical significance. In general, positive test results tended to reinforce intentions toward prophylactic surgery. In contrast, women not interested in surgery at the time of entry tended to remain reluctant after testing and counseling.

From the Departments of *Surgery, †Medicine, and ‡Family and Community Medicine, Duke University Medical Center, Durham, North Carolina; the §Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; and the ∥Dana-Farber Cancer Institute, Boston, Massachusetts

Correspondence: J. Dirk Iglehart, MD, Dept. of Surgery, Brigham and Women’s Hospital, 75 Francis St., Boston, MA 02115.

Presented at the 111th Annual Meeting of the Southern Surgical Association, December 5–8, 1999, The Homestead, Hot Springs, Virginia.

Supported by the Duke Specialized Program of Research Excellence (SPORE) in Breast Cancer from the National Cancer Institute.

E-mail: jiglehart@partners.org

Accepted for publication December 1999.

© 2000 Lippincott Williams & Wilkins, Inc.