Uptake of risk-reducing surgery in unaffected women at high risk of breast and ovarian cancer is risk, age, and time dependent.
OBJECTIVE
The uptake of risk-reducing surgery in women at increased risk of breast and ovarian cancer is highly variable between countries and centers within countries. We have investigated the rate, timing, and age of uptake of surgery in the northwest of England to report the results after up to 7 years in a Regional Genetics center.


METHODS
Uptake was documented in 211 known unaffected BRCA1/2 mutation carriers from 509 families and in 3,515 women at >25% lifetime risk of breast cancer without known mutations.


RESULTS
Of the 211 mutation carriers, 40% opted for bilateral risk-reducing mastectomy (BRRM) and 45% underwent bilateral risk-reducing salpingo-oophorectomy (BRRSPO). Uptake of BRRM was significantly related to lifetime risk and age but continued over several years. In women not known to carry a BRCA mutation, 6.4% of women at 40% to 45% lifetime risk, 2.5% of women at 33% to 39% lifetime risk, and 1.8% of women at 25% to 32% lifetime risk underwent BRRM (P < 0.005). BRRSPO uptake was greater in BRCA1 (52%) than BRCA2 (28%) carriers but in both groups tended to occur within the first 2 years after gene test (except in the youngest age group) and in women between the ages of 35 and 45.


CONCLUSIONS
To truly assess the uptake of risk-reducing surgery, longer-term follow-up is necessary particularly in younger women who are likely to delay BRRSPO. Careful risk counseling does seem to influence women's decisions for surgery, although the effect is not immediate.
Evans
D Gareth R
DG
Regional Genetic Service, The University of Manchester, St.Mary's Hospital, Manchester, United Kingdom. Gareth.evans@cmft.nhs.uk
Lalloo
Fiona
F
Ashcroft
Linda
L
Shenton
Andrew
A
Clancy
Tara
T
Baildam
Andrew D
AD
Brain
Anne
A
Hopwood
Penelope
P
Howell
Anthony
A
D000328:Adult; D000367:Age Factors; D001943:Breast Neoplasms / Q000235:genetics / Q000517:prevention & control / Q000601:surgery*; D004739:England; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D006801:Humans; D008408:Mastectomy / Q000706:statistics & numerical data*; D008875:Middle Aged; D009154:Mutation; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control / Q000601:surgery*; D010052:Ovariectomy / Q000706:statistics & numerical data*; D012307:Risk Factors; D013995:Time