Factors influencing uptake of BRCA1/2 testing and contralateral prophylactic mastectomy among Chinese breast cancer patients

Pathogenic mutations in breast cancer susceptibility gene 1/2 (BRCA1/2) are well established to increase the risk of breast cancer. However, few studies have examined the acceptance of genetic testing and contralateral prophylactic mastectomy (CPM) among Chinese breast cancer patients. This study aims to evaluate the knowledge and attitudes regarding genetic testing and risk management among Chinese women with breast cancer, and to identify factors associated with their intentions to pursue such management strategies. We conducted a prospective analysis using questionnaire-based surveys to assess attitudes toward BRCA1/2 genetic testing and the acceptance of CPM among 608 newly diagnosed breast cancer patients at Peking University International Hospital between May 2020 and May 2025. Multivariate analysis was performed to identify factors influencing these attitudes. Participants ranged from 22 to 87 years (mean ± standard deviation: 51.8 ± 12.3 years); 589 (96.9%) were married and 546 (89.8%) had children. Overall, 325 patients (53.5%) expressed willingness to undergo BRCA1/2 genetic testing, whereas only 191 (31.4%) would consider CPM if carrying a pathogenic BRCA1/2 mutation. Multivariate analysis identified age (odds ratio [OR] = 0.978, 95% confidence interval [CI]: 0.963-0.992, P = .003), prior counseling from healthcare professionals on genetic risk (OR = 2.358, 95% CI: 1.505-3.694, P = .000), and awareness of the "Angelina Jolie effect" (OR = 1.857, 95% CI: 1.277-2.699, P = .001) as independent predictors of willingness to undergo genetic testing. For CPM, independent predictors included age (OR = 0.983, 95% CI: 0.968-0.999, P = .039) and prior counseling on genetic risk (OR = 1.576, 95% CI: 1.035-2.401, P = .034). Professional genetic counseling and celebrity influence are key determinants of breast cancer patients' awareness of BRCA testing and uptake of risk-reducing surgery, underscoring the need for clinicians to integrate these factors into patient-centered decision-making.