title: Uptake, time course, and predictors of risk-reducing surgeries in BRCA carriers.
abstract: OBJECTIVE
  For women who carry BRCA mutations, risk-reducing surgeries are an option to decrease breast and ovarian cancer risk. This study aims to determine the uptake, time course, and predictors of risk-reducing mastectomy (RRM) and risk-reducing salpingo-oophorectomy (RRSO) in BRCA carriers.
  
  
  RESULTS
  In 272 female carriers, followed for a median of 3.7 years, 23% of those eligible chose RRM, and 51% percent chose RRSO. Among BRCA carriers who chose these procedures, median time to both RRM and RRSO was approximately 4 months after learning of BRCA-positive results. Predictors of RRM were as follows: age below 60 years (hazard ratio 1.8, p=0.04), prior breast cancer (hazard ratio 2.4, p=0.0004), and RRSO (hazard ratio 7.2, p<0.0001). Predictors of RRSO were as follows: age below 60 years (hazard ratio 3.6, p=0.006), prior breast cancer (hazard ratio 1.8, p=0.002), and RRM (hazard ratio 5.4, p<0.0001).
  
  
  CONCLUSIONS
  Many women who undergo BRCA testing use these results to make clinical decisions; those who choose risk-reducing surgeries typically do so within months of receiving BRCA-positive results. Predictors of risk-reducing surgery uptake include the following: age below 60 years, prior breast cancer, and utilization of another risk-reducing surgery. Future research directions include examining other preventive and screening options in BRCA carriers as well as studying motivations for choosing or declining risk-reducing surgeries.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA. mary.beattie@ucsfmedctr.org
authors.forename: Mary S
authors.initials: MS
authors.lastname: Beattie
authors.forename: Beth
authors.initials: B
authors.lastname: Crawford
authors.forename: Feng
authors.initials: F
authors.lastname: Lin
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: John
authors.initials: J
authors.lastname: Ziegler
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000235:genetics* / Q000517:prevention & control* / Q000601:surgery; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005820:Genetic Testing; D006579:Heterozygote; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009154:Mutation; D010051:Ovarian Neoplasms / Q000235:genetics* / Q000517:prevention & control* / Q000601:surgery; D010052:Ovariectomy; D040242:Risk Reduction Behavior; D013997:Time Factors; D055815:Young Adult