title: Genetic counseling impacts decision for prophylactic surgery for patients perceived to be at high risk for breast cancer.
abstract: BACKGROUND
  This study addresses the impact a comprehensive genetic counseling program had on women considering prophylactic mastectomy or oophorectomy.
  
  
  METHODS
  Sixty patients underwent detailed family evaluation and risk was estimated. Recommendations were made regarding testing. Ramifications of testing were discussed in detail.
  
  
  RESULTS
  Thirty-one women (37%) were considering prophylactic surgery believing themselves to be at high risk. Of these, 23 had testing recommended. Seven patients proceeded with prophylactic surgery based solely on high-risk assessment. Ten women were tested; five were positive. Three patients proceeded with prophylactic surgery despite a negative test. One decided against surgery despite a positive test. After counseling, prophylactic surgery was performed in just over half the initial candidates.
  
  
  CONCLUSIONS
  Breast cancer risk estimation and genetic evaluation can be complex. Comprehensive genetic risk assessment programs can play a significant role in the management of patients considering prophylactic surgery for perceived high risk.
authors.affiliation: Department of Surgery, Oregon Health Sciences University, and Legacy Cancer Services, 1130 NW 22nd, Suite 500, Portland, OR 97210, USA.
authors.forename: K T
authors.initials: KT
authors.lastname: Morris
authors.forename: N
authors.initials: N
authors.lastname: Johnson
authors.forename: N
authors.initials: N
authors.lastname: Krasikov
authors.forename: M
authors.initials: M
authors.lastname: Allen
authors.forename: P
authors.initials: P
authors.lastname: Dorsey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D051017:Apoptosis Regulatory Proteins; D024682:BRCA2 Protein; D001943:Breast Neoplasms / Q000235:genetics* / Q000517:prevention & control / Q000601:surgery*; D002648:Child; D004252:DNA Mutational Analysis; D003657:Decision Making; D005260:Female; D019398:Genes, BRCA1 / Q000235:genetics*; D005817:Genetic Counseling; D005820:Genetic Testing; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000235:genetics*; D010375:Pedigree; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D051017:Apoptosis Regulatory Proteins; C118024:BLID protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human; D009363:Neoplasm Proteins