title: Comparing Coordinated Versus Sequential Salpingo-Oophorectomy for BRCA1 and BRCA2 Mutation Carriers With Breast Cancer.
abstract: Women with breast cancer who carry BRCA1 or BRCA2 mutations must also consider risk-reducing salpingo-oophorectomy (RRSO) and how to coordinate this procedure with their breast surgery. We report the factors associated with coordinated versus sequential surgery and compare the outcomes of each.
  
  
  
  Patients in our cancer risk database who had breast cancer and a known deleterious BRCA1/2 mutation before undergoing breast surgery were included. Women who chose concurrent RRSO at the time of breast surgery were compared to those who did not.
  
  
  
  Sixty-two patients knew their mutation carrier status before undergoing breast cancer surgery. Forty-three patients (69%) opted for coordinated surgeries, and 19 (31%) underwent sequential surgeries at a median follow-up of 4.4 years. Women who underwent coordinated surgery were significantly older than those who chose sequential surgery (median age of 45 vs. 39 years; P = .025). There were no differences in comorbidities between groups. Patients who received neoadjuvant chemotherapy were more likely to undergo coordinated surgery (65% vs. 37%; P = .038). Sequential surgery patients had longer hospital stays (4.79 vs. 3.44 days, P = .01) and longer operating times (8.25 vs. 6.38 hours, P = .006) than patients who elected combined surgery. Postoperative complications were minor and were no more likely in either group (odds ratio, 4.76; 95% confidence interval, 0.56-40.6).
  
  
  
  Coordinating RRSO with breast surgery is associated with receipt of neoadjuvant chemotherapy, longer operating times, and hospital stays without an observed increase in complications. In the absence of risk, surgical options can be personalized.
authors: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA. Electronic address: Jocelyn.chapman@ucsf.edu.
authors: Jocelyn
authors: J
authors: S Chapman
authors: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.
authors: Erika
authors: E
authors: Roddy
authors: Department of Obstetrics and Gynecology, University of Washington, Seattle, WA.
authors: Anna
authors: A
authors: Panighetti
authors: Division of Surgical Oncology, Duke Medical Center, Durham, NC.
authors: Shelley
authors: S
authors: Hwang
authors: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.
authors: Beth
authors: B
authors: Crawford
authors: San Francisco Division of Gynecologic Oncology, Kaiser Permanente, San Francisco, CA.
authors: Bethan
authors: B
authors: Powell
authors: Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.
authors: Lee-May
authors: LM
authors: Chen
mesh_terms: D000328:Adult; D019313:BRCA1 Protein / Q000235:genetics; D024682:BRCA2 Protein / Q000235:genetics; D001943:Breast Neoplasms / Q000188:drug therapy / Q000235:genetics / Q000601:surgery*; D003657:Decision Making; D005185:Fallopian Tube Neoplasms / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D020022:Genetic Predisposition to Disease; D006801:Humans; D007902:Length of Stay; D008408:Mastectomy; D008875:Middle Aged; D009154:Mutation; D020360:Neoadjuvant Therapy; D061646:Operative Time; D010051:Ovarian Neoplasms / Q000517:prevention & control*; D010052:Ovariectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D065286:Prophylactic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D058994:Salpingectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D019313:BRCA1 Protein; C492913:BRCA1 protein, human; D024682:BRCA2 Protein; C551750:BRCA2 protein, human
keywords: Breast surgery; Gynecologic oncology; Risk-reducing bilateral salpingo-oophorectomy; Shared decision making; Surgical outcomes