title: Uptake of risk-reducing salpingo-oophorectomy in women carrying a BRCA1 or BRCA2 mutation: evidence for lower uptake in women affected by breast cancer and older women.
abstract: BACKGROUND
  Bilateral risk-reducing salpingo-oophorectomy (BRRSO) is the only effective way of reducing mortality from ovarian cancer. This study investigates uptake of BRRSO in 700 BRCA1/2 mutation carriers from Greater Manchester.
  
  
  METHODS
  Dates of last follow-up and BRRSO were obtained, and the following variables were investigated: ovarian cancer risk/gene, age and breast cancer history. The date of the genetic mutation report was the initiation for Kaplan-Meier analysis.
  
  
  RESULTS
  The uptake of BRRSO in BRCA1 mutation carriers was 54.5% (standard error 3.6%) at 5 years post testing compared with 45.5% (standard error 3.2%) in BRCA2 mutation carriers (P=0.045). The 40-59 years category showed the greatest uptake for BRRSO and uptake was significantly lower in the over 60 s (P<0.0001). Of the unaffected BRCA1 mutation carriers, 65% (standard error 5.1%) opted for surgery at 5 years post-testing compared with 41.1% (standard error 5.1%) in affected BRCA1 mutation carriers (P=0.045).
  
  
  CONCLUSIONS
  The uptake of BRRSO is lower in women previously affected by breast cancer and in older women. As there is no efficient method for early detection of ovarian cancer, uptake should ideally be greater. Counselling should be offered to ensure BRCA1/2 mutation carriers make an informed decision about managing their ovarian cancer risk.
authors.affiliation: Department of Genetic Medicine, The University of Manchester, Manchester Academic Health Science Centre, Central Manchester University Hospitals Foundation Trust, St. Mary's Hospital, Manchester, UK.
authors.forename: L
authors.initials: L
authors.lastname: Sidon
authors.forename: S
authors.initials: S
authors.lastname: Ingham
authors.forename: T
authors.initials: T
authors.lastname: Clancy
authors.forename: R
authors.initials: R
authors.lastname: Clayton
authors.forename: A
authors.initials: A
authors.lastname: Clarke
authors.forename: E A
authors.initials: EA
authors.lastname: Jones
authors.forename: F
authors.initials: F
authors.lastname: Lalloo
authors.forename: D G R
authors.initials: DG
authors.lastname: Evans
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology / Q000235:genetics; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D006801:Humans; D008875:Middle Aged; D009154:Mutation; D010051:Ovarian Neoplasms / Q000235:genetics / Q000517:prevention & control* / Q000601:surgery; D010052:Ovariectomy / Q000706:statistics & numerical data*; D012307:Risk Factors; D058994:Salpingectomy / Q000706:statistics & numerical data*