Prophylactic Risk-Reducing Mastectomy (PRRM): A Set Practice or Catch-22 Situation in LMIC. A Single-Centre Prospective Cohort Study
Background Pakistan’s hereditary breast cancer has a higher-than-average prevalence. Our acceptability of prophylactic risk-reducing mastectomy (PRRM) still needs to be determined, and genetic testing still needs to be offered to all eligible. The aim is to determine the number of women presenting t...
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| Veröffentlicht in: | World journal of surgery 2023-09, Vol.47 (9), p.2154-2160 |
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| creator | Mooghal, Mehwish Vohra, Lubna M. Khan, Wajiha Akbar, Fizza |
| description | Background
Pakistan’s hereditary breast cancer has a higher-than-average prevalence. Our acceptability of prophylactic risk-reducing mastectomy (PRRM) still needs to be determined, and genetic testing still needs to be offered to all eligible. The aim is to determine the number of women presenting to our centre who availed of PRRM after positive genetic tests and the main reasons restraining them from considering PRRM.
Materials and methods
This study is a single-centre, prospective cohort. We collected data from 2017 to 2022 on BRCA1/2 and other (
P
/LP) gene-positive patients. Continuous variables are presented as means (±SD) and categorical variables in percentages, with a significant
P
-value of ≤ 0.05.
Results
Out of 477 tested individuals, only 95(20.12%) had a positive result. BRCA1/2 was positive in 70 cases, while
P
/LP variants were in 24 cases. Only 32.6% of eligible families underwent genetic testing, with 54.8% positivity. Altogether, 92.6% of patients had BRCA1/2-related cancers. Only 25/95(26.3%) individuals availed of PRRM, the majority had contralateral risk-reducing mastectomy 68% with a 20% reconstruction rate. The main reasons to decline PRRM were false belief of not having any disease 57.44%, followed by family/spouse pressure 51%, body appearance/societal perception, fear of complications/quality of life and financial constraints.
Conclusion
Genetic testing and its implications are still a grey area for LMICs, primarily due to the scarcity of centres offering genetic testing to eligible populations, followed by prevalent perceptions about prophylactic surgeries among the masses. Addressing relevant issues in LMICs is the need of time. |
| doi_str_mv | 10.1007/s00268-023-07033-1 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2810923238</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2843643141</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3771-336ff634c5f8f5e00f0852f3eb72799b0c026cf428451362c047b40eaca80b263</originalsourceid><addsrcrecordid>eNqNkcFv0zAYxS0EYmXwD3BAlriMg8dnO43T3UbEYKgVVQviaKXul9UjjTvbAeXOH47TDJA4IE724fee3vceIc85nHMA9ToAiLxgICQDBVIy_oBMeCYFE1LIh2QCMs_Sn8sT8iSEWwCucsgfkxOpeDblUk3Ij6V3h13fVCZaQ1c2fGUr3HbGtjd0UYWIJrp9T8-Wq9Xi1QW9pGuMdOmPOFLnaVlFs2NC0LWNXRWta6lt6XxxXZ4PdPJpkJXYRo9J58IhOdpvSEu3cz7Sdey2_VPyqK6agM_u31Py-ertp_I9m398d11ezpmRSnEmZV7XuczMtC7qKQLUUExFLXGjhJrNNmBSH6bORDEclwsDmdpkgJWpCtiIXJ6Ss9H34N1dhyHqvQ0Gm6Zq0XVBi4LDbOiuSOjLv9Bb1_k2pUtUlnqVPOOJEiNl0mXBY60P3u4r32sOethIjxvptJE-bqQH0Yt7626zx-1vya9REnAxAt9tg_1_WOovH9ZvrkDAMZIcxSHp2hv0f4L_I9NPHDuqTw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2843643141</pqid></control><display><type>article</type><title>Prophylactic Risk-Reducing Mastectomy (PRRM): A Set Practice or Catch-22 Situation in LMIC. A Single-Centre Prospective Cohort Study</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Springer Nature - Complete Springer Journals</source><creator>Mooghal, Mehwish ; Vohra, Lubna M. ; Khan, Wajiha ; Akbar, Fizza</creator><creatorcontrib>Mooghal, Mehwish ; Vohra, Lubna M. ; Khan, Wajiha ; Akbar, Fizza</creatorcontrib><description>Background
Pakistan’s hereditary breast cancer has a higher-than-average prevalence. Our acceptability of prophylactic risk-reducing mastectomy (PRRM) still needs to be determined, and genetic testing still needs to be offered to all eligible. The aim is to determine the number of women presenting to our centre who availed of PRRM after positive genetic tests and the main reasons restraining them from considering PRRM.
Materials and methods
This study is a single-centre, prospective cohort. We collected data from 2017 to 2022 on BRCA1/2 and other (
P
/LP) gene-positive patients. Continuous variables are presented as means (±SD) and categorical variables in percentages, with a significant
P
-value of ≤ 0.05.
Results
Out of 477 tested individuals, only 95(20.12%) had a positive result. BRCA1/2 was positive in 70 cases, while
P
/LP variants were in 24 cases. Only 32.6% of eligible families underwent genetic testing, with 54.8% positivity. Altogether, 92.6% of patients had BRCA1/2-related cancers. Only 25/95(26.3%) individuals availed of PRRM, the majority had contralateral risk-reducing mastectomy 68% with a 20% reconstruction rate. The main reasons to decline PRRM were false belief of not having any disease 57.44%, followed by family/spouse pressure 51%, body appearance/societal perception, fear of complications/quality of life and financial constraints.
Conclusion
Genetic testing and its implications are still a grey area for LMICs, primarily due to the scarcity of centres offering genetic testing to eligible populations, followed by prevalent perceptions about prophylactic surgeries among the masses. Addressing relevant issues in LMICs is the need of time.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-023-07033-1</identifier><identifier>PMID: 37145137</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Abdominal Surgery ; BRCA1 protein ; BRCA1 Protein - genetics ; BRCA2 Protein - genetics ; Breast cancer ; Breast Neoplasms - genetics ; Breast Neoplasms - prevention & control ; Breast Neoplasms - surgery ; Cardiac Surgery ; Cohort analysis ; Complications ; Continuity (mathematics) ; Developing Countries ; Female ; General Surgery ; Genetic screening ; Genetic testing ; Humans ; Mastectomy ; Medicine ; Medicine & Public Health ; Mutation ; Original Scientific Report ; Population genetics ; Prospective Studies ; Quality of Life ; Risk ; Surgery ; Thoracic Surgery ; Vascular Surgery</subject><ispartof>World journal of surgery, 2023-09, Vol.47 (9), p.2154-2160</ispartof><rights>The Author(s) under exclusive licence to Société Internationale de Chirurgie 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><rights>2023. The Author(s) under exclusive licence to Société Internationale de Chirurgie.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c3771-336ff634c5f8f5e00f0852f3eb72799b0c026cf428451362c047b40eaca80b263</cites><orcidid>0000-0002-6386-4047</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00268-023-07033-1$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00268-023-07033-1$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,1411,27903,27904,41467,42536,45553,45554,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37145137$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mooghal, Mehwish</creatorcontrib><creatorcontrib>Vohra, Lubna M.</creatorcontrib><creatorcontrib>Khan, Wajiha</creatorcontrib><creatorcontrib>Akbar, Fizza</creatorcontrib><title>Prophylactic Risk-Reducing Mastectomy (PRRM): A Set Practice or Catch-22 Situation in LMIC. A Single-Centre Prospective Cohort Study</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background
Pakistan’s hereditary breast cancer has a higher-than-average prevalence. Our acceptability of prophylactic risk-reducing mastectomy (PRRM) still needs to be determined, and genetic testing still needs to be offered to all eligible. The aim is to determine the number of women presenting to our centre who availed of PRRM after positive genetic tests and the main reasons restraining them from considering PRRM.
Materials and methods
This study is a single-centre, prospective cohort. We collected data from 2017 to 2022 on BRCA1/2 and other (
P
/LP) gene-positive patients. Continuous variables are presented as means (±SD) and categorical variables in percentages, with a significant
P
-value of ≤ 0.05.
Results
Out of 477 tested individuals, only 95(20.12%) had a positive result. BRCA1/2 was positive in 70 cases, while
P
/LP variants were in 24 cases. Only 32.6% of eligible families underwent genetic testing, with 54.8% positivity. Altogether, 92.6% of patients had BRCA1/2-related cancers. Only 25/95(26.3%) individuals availed of PRRM, the majority had contralateral risk-reducing mastectomy 68% with a 20% reconstruction rate. The main reasons to decline PRRM were false belief of not having any disease 57.44%, followed by family/spouse pressure 51%, body appearance/societal perception, fear of complications/quality of life and financial constraints.
Conclusion
Genetic testing and its implications are still a grey area for LMICs, primarily due to the scarcity of centres offering genetic testing to eligible populations, followed by prevalent perceptions about prophylactic surgeries among the masses. Addressing relevant issues in LMICs is the need of time.</description><subject>Abdominal Surgery</subject><subject>BRCA1 protein</subject><subject>BRCA1 Protein - genetics</subject><subject>BRCA2 Protein - genetics</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - genetics</subject><subject>Breast Neoplasms - prevention & control</subject><subject>Breast Neoplasms - surgery</subject><subject>Cardiac Surgery</subject><subject>Cohort analysis</subject><subject>Complications</subject><subject>Continuity (mathematics)</subject><subject>Developing Countries</subject><subject>Female</subject><subject>General Surgery</subject><subject>Genetic screening</subject><subject>Genetic testing</subject><subject>Humans</subject><subject>Mastectomy</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Mutation</subject><subject>Original Scientific Report</subject><subject>Population genetics</subject><subject>Prospective Studies</subject><subject>Quality of Life</subject><subject>Risk</subject><subject>Surgery</subject><subject>Thoracic Surgery</subject><subject>Vascular Surgery</subject><issn>0364-2313</issn><issn>1432-2323</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqNkcFv0zAYxS0EYmXwD3BAlriMg8dnO43T3UbEYKgVVQviaKXul9UjjTvbAeXOH47TDJA4IE724fee3vceIc85nHMA9ToAiLxgICQDBVIy_oBMeCYFE1LIh2QCMs_Sn8sT8iSEWwCucsgfkxOpeDblUk3Ij6V3h13fVCZaQ1c2fGUr3HbGtjd0UYWIJrp9T8-Wq9Xi1QW9pGuMdOmPOFLnaVlFs2NC0LWNXRWta6lt6XxxXZ4PdPJpkJXYRo9J58IhOdpvSEu3cz7Sdey2_VPyqK6agM_u31Py-ertp_I9m398d11ezpmRSnEmZV7XuczMtC7qKQLUUExFLXGjhJrNNmBSH6bORDEclwsDmdpkgJWpCtiIXJ6Ss9H34N1dhyHqvQ0Gm6Zq0XVBi4LDbOiuSOjLv9Bb1_k2pUtUlnqVPOOJEiNl0mXBY60P3u4r32sOethIjxvptJE-bqQH0Yt7626zx-1vya9REnAxAt9tg_1_WOovH9ZvrkDAMZIcxSHp2hv0f4L_I9NPHDuqTw</recordid><startdate>202309</startdate><enddate>202309</enddate><creator>Mooghal, Mehwish</creator><creator>Vohra, Lubna M.</creator><creator>Khan, Wajiha</creator><creator>Akbar, Fizza</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-6386-4047</orcidid></search><sort><creationdate>202309</creationdate><title>Prophylactic Risk-Reducing Mastectomy (PRRM): A Set Practice or Catch-22 Situation in LMIC. A Single-Centre Prospective Cohort Study</title><author>Mooghal, Mehwish ; Vohra, Lubna M. ; Khan, Wajiha ; Akbar, Fizza</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3771-336ff634c5f8f5e00f0852f3eb72799b0c026cf428451362c047b40eaca80b263</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdominal Surgery</topic><topic>BRCA1 protein</topic><topic>BRCA1 Protein - genetics</topic><topic>BRCA2 Protein - genetics</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - genetics</topic><topic>Breast Neoplasms - prevention & control</topic><topic>Breast Neoplasms - surgery</topic><topic>Cardiac Surgery</topic><topic>Cohort analysis</topic><topic>Complications</topic><topic>Continuity (mathematics)</topic><topic>Developing Countries</topic><topic>Female</topic><topic>General Surgery</topic><topic>Genetic screening</topic><topic>Genetic testing</topic><topic>Humans</topic><topic>Mastectomy</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Mutation</topic><topic>Original Scientific Report</topic><topic>Population genetics</topic><topic>Prospective Studies</topic><topic>Quality of Life</topic><topic>Risk</topic><topic>Surgery</topic><topic>Thoracic Surgery</topic><topic>Vascular Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mooghal, Mehwish</creatorcontrib><creatorcontrib>Vohra, Lubna M.</creatorcontrib><creatorcontrib>Khan, Wajiha</creatorcontrib><creatorcontrib>Akbar, Fizza</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>World journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mooghal, Mehwish</au><au>Vohra, Lubna M.</au><au>Khan, Wajiha</au><au>Akbar, Fizza</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prophylactic Risk-Reducing Mastectomy (PRRM): A Set Practice or Catch-22 Situation in LMIC. A Single-Centre Prospective Cohort Study</atitle><jtitle>World journal of surgery</jtitle><stitle>World J Surg</stitle><addtitle>World J Surg</addtitle><date>2023-09</date><risdate>2023</risdate><volume>47</volume><issue>9</issue><spage>2154</spage><epage>2160</epage><pages>2154-2160</pages><issn>0364-2313</issn><eissn>1432-2323</eissn><abstract>Background
Pakistan’s hereditary breast cancer has a higher-than-average prevalence. Our acceptability of prophylactic risk-reducing mastectomy (PRRM) still needs to be determined, and genetic testing still needs to be offered to all eligible. The aim is to determine the number of women presenting to our centre who availed of PRRM after positive genetic tests and the main reasons restraining them from considering PRRM.
Materials and methods
This study is a single-centre, prospective cohort. We collected data from 2017 to 2022 on BRCA1/2 and other (
P
/LP) gene-positive patients. Continuous variables are presented as means (±SD) and categorical variables in percentages, with a significant
P
-value of ≤ 0.05.
Results
Out of 477 tested individuals, only 95(20.12%) had a positive result. BRCA1/2 was positive in 70 cases, while
P
/LP variants were in 24 cases. Only 32.6% of eligible families underwent genetic testing, with 54.8% positivity. Altogether, 92.6% of patients had BRCA1/2-related cancers. Only 25/95(26.3%) individuals availed of PRRM, the majority had contralateral risk-reducing mastectomy 68% with a 20% reconstruction rate. The main reasons to decline PRRM were false belief of not having any disease 57.44%, followed by family/spouse pressure 51%, body appearance/societal perception, fear of complications/quality of life and financial constraints.
Conclusion
Genetic testing and its implications are still a grey area for LMICs, primarily due to the scarcity of centres offering genetic testing to eligible populations, followed by prevalent perceptions about prophylactic surgeries among the masses. Addressing relevant issues in LMICs is the need of time.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>37145137</pmid><doi>10.1007/s00268-023-07033-1</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-6386-4047</orcidid></addata></record> |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete; Springer Nature - Complete Springer Journals |
| subjects | Abdominal Surgery BRCA1 protein BRCA1 Protein - genetics BRCA2 Protein - genetics Breast cancer Breast Neoplasms - genetics Breast Neoplasms - prevention & control Breast Neoplasms - surgery Cardiac Surgery Cohort analysis Complications Continuity (mathematics) Developing Countries Female General Surgery Genetic screening Genetic testing Humans Mastectomy Medicine Medicine & Public Health Mutation Original Scientific Report Population genetics Prospective Studies Quality of Life Risk Surgery Thoracic Surgery Vascular Surgery |
| title | Prophylactic Risk-Reducing Mastectomy (PRRM): A Set Practice or Catch-22 Situation in LMIC. A Single-Centre Prospective Cohort Study |
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