title: Risk reduction and survival benefit of prophylactic surgery in BRCA mutation carriers, a systematic review.
abstract: BACKGROUND
  Mutations in BRCA1 or BRCA2 genes results in an elevated risk for developing both breast and ovarian cancers over the lifetime of affected carriers. General surgeons may be faced with questions about surgical risk reduction and survival benefit of prophylactic surgery.
  
  
  METHODS
  A systematic literature review was performed using the electronic databases PubMed, OVID MEDLINE, and Scopus comparing prophylactic surgery vs observation with respect to breast and ovarian cancer risk reduction and mortality in BRCA mutation carriers.
  
  
  RESULTS
  Bilateral risk-reducing mastectomy provides a 90% to 95% risk reduction in BRCA mutation carriers, although the data do not demonstrate improved mortality. The reduction in ovarian and breast cancer risks using risk-reducing bilateral salpingo-oophorectomy has translated to improvement in survival.
  
  
  CONCLUSIONS
  Clinical management of patients at increased risk for breast cancer requires consideration of risk, patient preference, and quality of life.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Carmel, IN, USA.
authors.forename: Kandice K
authors.initials: KK
authors.lastname: Ludwig
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Joan
authors.initials: J
authors.lastname: Neuner
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
authors.forename: Annabelle
authors.initials: A
authors.lastname: Butler
authors.affiliation: Human and Molecular Genetics Center, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Geurts
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA. Electronic address: akong@mcw.edu.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Kong
mesh_terms: D001943:Breast Neoplasms / Q000235:genetics / Q000401:mortality / Q000517:prevention & control; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006579:Heterozygote; D006801:Humans; D009154:Mutation; D010051:Ovarian Neoplasms / Q000235:genetics / Q000401:mortality / Q000517:prevention & control; D010052:Ovariectomy; D000072036:Prophylactic Mastectomy; D065286:Prophylactic Surgical Procedures; D058994:Salpingectomy
keywords: BRCA; Mastectomy; Oophorectomy; Prophylactic; Risk reducing