title: Preoperative risk assessment among women undergoing bilateral prophylactic mastectomy for cancer risk reduction.
abstract: BACKGROUND
  Cancer risk assessment is an important decision-making tool for women considering irreversible risk-reducing surgery. Our objective was to determine the prevalence of BRCA testing among women undergoing bilateral prophylactic mastectomy (BPM) and to review the characteristics of women who choose BPM within a metropolitan setting.
  
  
  METHODS
  We retrospectively reviewed records of women who underwent BPM in the absence of cancer within 2 health care systems that included 5 metropolitan hospitals. Women with invasive carcinoma or ductal carcinoma in situ (DCIS) were excluded; neither lobular carcinoma in situ (LCIS) nor atypical hyperplasia (AH) were exclusion criteria. We collected demographic information and preoperative screening and risk assessment, BRCA testing, reconstruction, and associated cancer risk-reducing surgery data. We compared women who underwent BRCA testing to those not tested.
  
  
  RESULTS
  From January 2002 to July 2009, a total of 71 BPMs were performed. Only 25 women (35.2%) had preoperative BRCA testing; 88% had a BRCA mutation. Compared with tested women, BRCA nontested women were significantly older (39.1 vs. 49.2 years, P < 0.001), had significantly more preoperative biopsies and mammograms and had fewer previous or simultaneous cancer risk-reducing surgery (oophorectomy). Among BRCA nontested women, common indications for BPM were family history of breast cancer (n = 21, 45.6%) or LCIS or AH (n = 16, 34.8%); 9 nontested women (19.6%) chose BPM based on exclusively on cancer-risk anxiety or personal preference.
  
  
  CONCLUSIONS
  Most women who underwent BPM did not receive preoperative genetic testing. Further studies are needed to corroborate our findings in other geographic regions and practice settings.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Natasha M
authors.initials: NM
authors.lastname: Rueth
authors.forename: Melissa
authors.initials: M
authors.lastname: McMahon
authors.forename: Amanda K
authors.initials: AK
authors.lastname: Arrington
authors.forename: Karen
authors.initials: K
authors.lastname: Swenson
authors.forename: Joseph
authors.initials: J
authors.lastname: Leach
authors.forename: Todd M
authors.initials: TM
authors.lastname: Tuttle
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D002278:Carcinoma in Situ / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D018275:Carcinoma, Lobular / Q000235:genetics / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005820:Genetic Testing; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D040242:Risk Reduction Behavior