title: Preoperative genetic testing affects surgical decision making in breast cancer patients.
abstract: OBJECTIVE
  Our aim was to determine if BRCA mutation status changes surgical decision making in women who undergo genetic testing after the diagnosis of breast cancer.
  
  
  METHODS
  This is a retrospective cohort study of breast cancer patients who had BRCA mutation testing performed prior to surgery. We compared surgical choice and change in surgical choice in women who tested positive for a BRCA mutation with those who tested negative. Surgery was considered the most definitive surgery within a year of diagnosis. Other data collected included age, race, stage, histology, receptor status, adjuvant treatment, gravity, parity, and family history. Variables were compared by BRCA status using Fisher's exact test and logistic regression.
  
  
  RESULTS
  Three hundred and two women were included. Thirty-two (10.6%) were identified as carrying a BRCA mutation. Most women had early stage disease (55.6% T1 lesions, 72.8% node negative); 55.6% had breast-conserving surgery, and the remaining had unilateral or bilateral mastectomy. BRCA mutation carriers were more likely to have both a personal history of breast cancer (RR 2.74, 95% CI=1.08-6.98) and hormone receptor-negative tumors (56.0% vs. 26.2%, p=0.002). BRCA mutation carriers were more likely to choose bilateral mastectomy with reconstruction (56.3% vs. 15.9%, p<0.0001); 71.9% of BRCA mutation carriers opted for a different surgery than what was initially planned by their surgeon as compared to 29% of mutation-negative patients (p<0.0001).
  
  
  CONCLUSIONS
  BRCA mutation testing strongly influences surgical decision making in newly diagnosed breast cancer patients. For women who meet NCCN referral guidelines, genetic evaluation should be performed prior to surgical intervention.
authors.affiliation: Division of Women's Oncology, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI, United States. Electronic address: elokich@wihri.org.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lokich
authors.affiliation: Division of Women's Oncology, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI, United States.
authors.forename: Ashley
authors.initials: A
authors.lastname: Stuckey
authors.affiliation: Division of Research, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI, United States.
authors.forename: Christina
authors.initials: C
authors.lastname: Raker
authors.affiliation: Division of Women's Oncology, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI, United States.
authors.forename: Jennifer Scalia
authors.initials: JS
authors.lastname: Wilbur
authors.affiliation: Division of Women's Oncology, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI, United States.
authors.forename: Jessica
authors.initials: J
authors.lastname: Laprise
authors.affiliation: Division of Women's Oncology, Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Women and Infants Hospital of Rhode Island, Providence, RI, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gass
mesh_terms: D001943:Breast Neoplasms / Q000235:genetics* / Q000601:surgery*; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D005820:Genetic Testing; D006801:Humans; D008408:Mastectomy; D008875:Middle Aged; D009154:Mutation; D057240:Patient Preference; D057234:Preoperative Period; D012189:Retrospective Studies
keywords: BRCA; Breast cancer; Genetic testing