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Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related CancerUS Preventive Services Task Force Recommendation Statement

Educational Objective
To review the US Preventive Services Task Force (USPSTF) recommendations regarding risk assessment, genetic counseling, and genetic testing for BRCA-related cancer.
1 Credit CME

Importance  Potentially harmful mutations of the breast cancer susceptibility 1 and 2 genes (BRCA1/2) are associated with increased risk for breast, ovarian, fallopian tube, and peritoneal cancer. For women in the United States, breast cancer is the most common cancer after nonmelanoma skin cancer and the second leading cause of cancer death. In the general population, BRCA1/2 mutations occur in an estimated 1 in 300 to 500 women and account for 5% to 10% of breast cancer cases and 15% of ovarian cancer cases.

Objective  To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer.

Evidence Review  The USPSTF reviewed the evidence on risk assessment, genetic counseling, and genetic testing for potentially harmful BRCA1/2 mutations in asymptomatic women who have never been diagnosed with BRCA-related cancer, as well as those with a previous diagnosis of breast, ovarian, tubal, or peritoneal cancer who have completed treatment and are considered cancer free. In addition, the USPSTF reviewed interventions to reduce the risk for breast, ovarian, tubal, or peritoneal cancer in women with potentially harmful BRCA1/2 mutations, including intensive cancer screening, medications, and risk-reducing surgery.

Findings  For women whose family or personal history is associated with an increased risk for harmful mutations in the BRCA1/2 genes, or who have an ancestry associated with BRCA1/2 gene mutations, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are moderate. For women whose personal or family history or ancestry is not associated with an increased risk for harmful mutations in the BRCA1/2 genes, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are small to none. Regardless of family or personal history, the USPSTF found adequate evidence that the overall harms of risk assessment, genetic counseling, genetic testing, and interventions are small to moderate.

Conclusions and Recommendation  The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with BRCA1/2 gene mutations with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing. (B recommendation) The USPSTF recommends against routine risk assessment, genetic counseling, or genetic testing for women whose personal or family history or ancestry is not associated with potentially harmful BRCA1/2 gene mutations. (D recommendation)

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Article Information

Corresponding Author: Douglas K. Owens, MD, MS, Stanford University, 616 Serra St, Encina Hall, Room C336, Stanford, CA 94305-6019 (

Correction: This article was corrected on October 11, 2019, for incorrect information in an author affiliation and on November 12, 2019, for an incorrect word that affected the meaning of a sentence.

The US Preventive Services Task Force (USPSTF) members: Douglas K. Owens, MD, MS; Karina W. Davidson, PhD, MASc; Alex H. Krist, MD, MPH; Michael J. Barry, MD; Michael Cabana, MD, MA, MPH; Aaron B. Caughey, MD, PhD; Chyke A. Doubeni, MD, MPH; John W. Epling Jr, MD, MSEd; Martha Kubik, PhD, RN; C. Seth Landefeld, MD; Carol M. Mangione, MD, MSPH; Lori Pbert, PhD; Michael Silverstein, MD, MPH; Melissa A. Simon, MD, MPH; Chien-Wen Tseng, MD, MPH, MSEE; John B. Wong, MD.

Affiliations of The US Preventive Services Task Force (USPSTF) members: Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Owens); Stanford University, Stanford, California (Owens); Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York (Davidson); Fairfax Family Practice Residency, Fairfax, Virginia (Krist); Virginia Commonwealth University, Richmond (Krist); Harvard Medical School, Boston, Massachusetts (Barry); University of California, San Francisco (Cabana); Oregon Health & Science University, Portland (Caughey); Mayo Clinic, Rochester, Minnesota (Doubeni); Virginia Tech Carilion School of Medicine, Roanoke (Epling Jr); Temple University, Philadelphia, Pennsylvania (Kubik); University of Alabama at Birmingham (Landefeld); University of California, Los Angeles (Mangione); University of Massachusetts Medical School, Worcester (Pbert); Boston University, Boston, Massachusetts (Silverstein); Northwestern University, Evanston, Illinois (Simon); University of Hawaii, Honolulu (Tseng); Pacific Health Research and Education Institute, Honolulu, Hawaii (Tseng); Tufts University School of Medicine, Boston, Massachusetts (Wong).

Author Contributions: Dr Owens had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The USPSTF members contributed equally to the recommendation statement.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Authors followed the policy regarding conflicts of interest described at All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings.

Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.

Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an Evidence-based Practice Center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.

Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services.

Additional Contributions: We thank Justin Mills, MD, MPH (AHRQ), who contributed to the writing of the manuscript, and Lisa Nicolella, MA (AHRQ), who assisted with coordination and editing.

Brody  LC, Biesecker  BB.  Breast cancer susceptibility genes: BRCA1 and BRCA2.  Medicine (Baltimore). 1998;77(3):208-226. doi:10.1097/00005792-199805000-00006PubMedGoogle ScholarCrossref
Mersch  J, Jackson  MA, Park  M,  et al.  Cancers associated with BRCA1 and BRCA2 mutations other than breast and ovarian.  Cancer. 2015;121(2):269-275. doi:10.1002/cncr.29041PubMedGoogle ScholarCrossref
Miki  Y, Swensen  J, Shattuck-Eidens  D,  et al.  A strong candidate for the breast and ovarian cancer susceptibility gene BRCA1.  Science. 1994;266(5182):66-71. doi:10.1126/science.7545954PubMedGoogle ScholarCrossref
Wooster  R, Weber  BL.  Breast and ovarian cancer.  N Engl J Med. 2003;348(23):2339-2347. doi:10.1056/NEJMra012284PubMedGoogle ScholarCrossref
Sherman  ME, Piedmonte  M, Mai  PL,  et al.  Pathologic findings at risk-reducing salpingo-oophorectomy: primary results from Gynecologic Oncology Group trial GOG-0199.  J Clin Oncol. 2014;32(29):3275-3283. doi:10.1200/JCO.2013.54.1987PubMedGoogle ScholarCrossref
Norquist  BM, Garcia  RL, Allison  KH,  et al.  The molecular pathogenesis of hereditary ovarian carcinoma: alterations in the tubal epithelium of women with BRCA1 and BRCA2 mutations.  Cancer. 2010;116(22):5261-5271. doi:10.1002/cncr.25439PubMedGoogle ScholarCrossref
American Cancer Society (ACS). Cancer Facts & Figures 2018. ACS website. Published 2018. Accessed July 3, 2019.
Antoniou  AC, Gayther  SA, Stratton  JF, Ponder  BA, Easton  DF.  Risk models for familial ovarian and breast cancer.  Genet Epidemiol. 2000;18(2):173-190. doi:10.1002/(SICI)1098-2272(200002)18:2<173::AID-GEPI6>3.0.CO;2-RPubMedGoogle ScholarCrossref
Anglian Breast Cancer Study Group.  Prevalence and penetrance of BRCA1 and BRCA2 mutations in a population-based series of breast cancer cases.  Br J Cancer. 2000;83(10):1301-1308. doi:10.1054/bjoc.2000.1407PubMedGoogle ScholarCrossref
Antoniou  AC, Pharoah  PD, McMullan  G,  et al.  A comprehensive model for familial breast cancer incorporating BRCA1, BRCA2 and other genes.  Br J Cancer. 2002;86(1):76-83. doi:10.1038/sj.bjc.6600008PubMedGoogle ScholarCrossref
Peto  J, Collins  N, Barfoot  R,  et al.  Prevalence of BRCA1 and BRCA2 gene mutations in patients with early-onset breast cancer.  J Natl Cancer Inst. 1999;91(11):943-949. doi:10.1093/jnci/91.11.943PubMedGoogle ScholarCrossref
Antoniou  A, Pharoah  PD, Narod  S,  et al.  Average risks of breast and ovarian cancer associated with BRCA1 or BRCA2 mutations detected in case series unselected for family history: a combined analysis of 22 studies.  Am J Hum Genet. 2003;72(5):1117-1130. doi:10.1086/375033PubMedGoogle ScholarCrossref
Chen  S, Parmigiani  G.  Meta-analysis of BRCA1 and BRCA2 penetrance.  J Clin Oncol. 2007;25(11):1329-1333. doi:10.1200/JCO.2006.09.1066PubMedGoogle ScholarCrossref
Moyer  VA; U.S. Preventive Services Task Force.  Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: U.S. Preventive Services Task Force recommendation statement.  Ann Intern Med. 2014;160(4):271-281. doi:10.7326/M13-2747PubMedGoogle ScholarCrossref
Gilpin  CA, Carson  N, Hunter  AG.  A preliminary validation of a family history assessment form to select women at risk for breast or ovarian cancer for referral to a genetics center.  Clin Genet. 2000;58(4):299-308. doi:10.1034/j.1399-0004.2000.580408.xPubMedGoogle ScholarCrossref
Oros  KK, Ghadirian  P, Maugard  CM,  et al.  Application of BRCA1 and BRCA2 mutation carrier prediction models in breast and/or ovarian cancer families of French Canadian descent.  Clin Genet. 2006;70(4):320-329. doi:10.1111/j.1399-0004.2006.00673.xPubMedGoogle ScholarCrossref
Panchal  SM, Ennis  M, Canon  S, Bordeleau  LJ.  Selecting a BRCA risk assessment model for use in a familial cancer clinic.  BMC Med Genet. 2008;9:116. doi:10.1186/1471-2350-9-116PubMedGoogle ScholarCrossref
Parmigiani  G, Chen  S, Iversen  ES  Jr,  et al.  Validity of models for predicting BRCA1 and BRCA2 mutations.  Ann Intern Med. 2007;147(7):441-450. doi:10.7326/0003-4819-147-7-200710020-00002PubMedGoogle ScholarCrossref
Antoniou  AC, Hardy  R, Walker  L,  et al.  Predicting the likelihood of carrying a BRCA1 or BRCA2 mutation: validation of BOADICEA, BRCAPRO, IBIS, Myriad and the Manchester scoring system using data from UK genetics clinics.  J Med Genet. 2008;45(7):425-431. doi:10.1136/jmg.2007.056556PubMedGoogle ScholarCrossref
Barcenas  CH, Hosain  GM, Arun  B,  et al.  Assessing BRCA carrier probabilities in extended families.  J Clin Oncol. 2006;24(3):354-360. doi:10.1200/JCO.2005.02.2368PubMedGoogle ScholarCrossref
Evans  DG, Eccles  DM, Rahman  N,  et al.  A new scoring system for the chances of identifying a BRCA1/2 mutation outperforms existing models including BRCAPRO.  J Med Genet. 2004;41(6):474-480. doi:10.1136/jmg.2003.017996PubMedGoogle ScholarCrossref
Bellcross  CA, Lemke  AA, Pape  LS, Tess  AL, Meisner  LT.  Evaluation of a breast/ovarian cancer genetics referral screening tool in a mammography population.  Genet Med. 2009;11(11):783-789. doi:10.1097/GIM.0b013e3181b9b04aPubMedGoogle ScholarCrossref
Hoskins  KF, Zwaagstra  A, Ranz  M.  Validation of a tool for identifying women at high risk for hereditary breast cancer in population-based screening.  Cancer. 2006;107(8):1769-1776. doi:10.1002/cncr.22202PubMedGoogle ScholarCrossref
Teller  P, Hoskins  KF, Zwaagstra  A,  et al.  Validation of the pedigree assessment tool (PAT) in families with BRCA1 and BRCA2 mutations.  Ann Surg Oncol. 2010;17(1):240-246. doi:10.1245/s10434-009-0697-9PubMedGoogle ScholarCrossref
Ashton-Prolla  P, Giacomazzi  J, Schmidt  AV,  et al.  Development and validation of a simple questionnaire for the identification of hereditary breast cancer in primary care.  BMC Cancer. 2009;9:283. doi:10.1186/1471-2407-9-283PubMedGoogle ScholarCrossref
Fischer  C, Kuchenbäcker  K, Engel  C,  et al; German Consortium for Hereditary Breast and Ovarian Cancer.  Evaluating the performance of the breast cancer genetic risk models BOADICEA, IBIS, BRCAPRO and Claus for predicting BRCA1/2 mutation carrier probabilities: a study based on 7352 families from the German Hereditary Breast and Ovarian Cancer Consortium.  J Med Genet. 2013;50(6):360-367. doi:10.1136/jmedgenet-2012-101415PubMedGoogle ScholarCrossref
Cuzick  J. IBIS Breast Cancer Risk Evaluation Tool, v8. 2017. Accessed July 25, 2019.
Nelson  HD, Pappas  M, Cantor  A, Haney  E, Holmes  R, Stillman  L.  Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: A Systematic Review for the US Preventive Services Task Force: Evidence Synthesis No. 182. Rockville, MD: Agency for Healthcare Research and Quality; 2019. AHRQ publication 19-05251-EF-1.
National Comprehensive Cancer Network (NCCN). Genetic/Familial High-Risk Assessment: Breast and Ovarian. NCCN website. Published 2012. Accessed July 3, 2019.
Association for Molecular Pathology et al v Myriad Genetics Inc et al, 133 S Ct 2107 (June 13, 2013).
Petrucelli  N, Daly  MB, Pal  T.  BRCA1- and BRCA2-Associated Hereditary Breast and Ovarian Cancer. Seattle: University of Washington; 2016.
Richards  S, Aziz  N, Bale  S,  et al; ACMG Laboratory Quality Assurance Committee.  Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology.  Genet Med. 2015;17(5):405-424. doi:10.1038/gim.2015.30PubMedGoogle ScholarCrossref
National Cancer Institute (NCI). NCI Cancer Genetics Services Directory. NCI website. Accessed July 3, 2018.
Moyer  VA; U.S. Preventive Services Task Force.  Medications to decrease the risk for breast cancer in women: recommendations from the U.S. Preventive Services Task Force recommendation statement.  Ann Intern Med. 2013;159(10):698-708.PubMedGoogle Scholar
Grossman  DC, Curry  SJ, Owens  DK,  et al; US Preventive Services Task Force.  Screening for ovarian cancer: US Preventive Services Task Force recommendation statement.  JAMA. 2018;319(6):588-594. doi:10.1001/jama.2017.21926PubMedGoogle ScholarCrossref
Bibbins-Domingo  K, Grossman  DC, Curry  SJ,  et al; US Preventive Services Task Force.  Screening for gynecologic conditions with pelvic examination: US Preventive Services Task Force recommendation statement.  JAMA. 2017;317(9):947-953. doi:10.1001/jama.2017.0807PubMedGoogle ScholarCrossref
Whittemore  AS, Gong  G, John  EM,  et al.  Prevalence of BRCA1 mutation carriers among U.S. non-Hispanic whites.  Cancer Epidemiol Biomarkers Prev. 2004;13(12):2078-2083.PubMedGoogle Scholar
Nelson  HD, Fu  R, Goddard  K,  et al.  Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: Systematic Review to Update the U.S. Preventive Services Task Force Recommendation: Evidence Synthesis No. 101. Rockville, MD: Agency for Healthcare Research and Quality; 2013. AHRQ publication 12-05164-EF-1.
Nelson  HD, Pappas  M, Cantor  A, Haney  E, Holmes  R.  Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: updated evidence report and systematic review for the US Preventive Services Task Force  [published August 20, 2019].  JAMA. doi:10.1001/jama.2019.8430Google Scholar
Kast  K, Schmutzler  RK, Rhiem  K,  et al.  Validation of the Manchester scoring system for predicting BRCA1/2 mutations in 9,390 families suspected of having hereditary breast and ovarian cancer.  Int J Cancer. 2014;135(10):2352-2361. doi:10.1002/ijc.28875PubMedGoogle ScholarCrossref
Biswas  S, Atienza  P, Chipman  J,  et al.  A two-stage approach to genetic risk assessment in primary care.  Breast Cancer Res Treat. 2016;155(2):375-383. doi:10.1007/s10549-016-3686-2PubMedGoogle ScholarCrossref
Albada  A, van Dulmen  S, Dijkstra  H, Wieffer  I, Witkamp  A, Ausems  MG.  Counselees’ expressed level of understanding of the risk estimate and surveillance recommendation are not associated with breast cancer surveillance adherence.  J Genet Couns. 2016;25(2):279-289. doi:10.1007/s10897-015-9869-xPubMedGoogle ScholarCrossref
Bowen  DJ, Burke  W, Yasui  Y, McTiernan  A, McLeran  D.  Effects of risk counseling on interest in breast cancer genetic testing for lower risk women.  Genet Med. 2002;4(5):359-365. doi:10.1097/00125817-200209000-00007PubMedGoogle ScholarCrossref
Burke  W, Culver  JO, Bowen  D,  et al.  Genetic counseling for women with an intermediate family history of breast cancer.  Am J Med Genet. 2000;90(5):361-368. doi:10.1002/(SICI)1096-8628(20000228)90:5<361::AID-AJMG4>3.0.CO;2-8PubMedGoogle ScholarCrossref
Cull  A, Miller  H, Porterfield  T,  et al.  The use of videotaped information in cancer genetic counselling: a randomized evaluation study.  Br J Cancer. 1998;77(5):830-837. doi:10.1038/bjc.1998.135PubMedGoogle ScholarCrossref
Lerman  C, Narod  S, Schulman  K,  et al.  BRCA1 testing in families with hereditary breast-ovarian cancer: a prospective study of patient decision making and outcomes.  JAMA. 1996;275(24):1885-1892. doi:10.1001/jama.1996.03530480027036PubMedGoogle ScholarCrossref
Bowen  DJ, Burke  W, McTiernan  A, Yasui  Y, Andersen  MR.  Breast cancer risk counseling improves women’s functioning.  Patient Educ Couns. 2004;53(1):79-86. doi:10.1016/S0738-3991(03)00122-8PubMedGoogle ScholarCrossref
Armstrong  K, Micco  E, Carney  A, Stopfer  J, Putt  M.  Racial differences in the use of BRCA1/2 testing among women with a family history of breast or ovarian cancer.  JAMA. 2005;293(14):1729-1736. doi:10.1001/jama.293.14.1729PubMedGoogle ScholarCrossref
Bennett  P, Wilkinson  C, Turner  J,  et al.  Factors associated with intrusive cancer-related worries in women undergoing cancer genetic risk assessment  [published correction appears in Fam Cancer. 2009;8(3):263].  Fam Cancer. 2009;8(2):159-165. doi:10.1007/s10689-008-9221-9PubMedGoogle ScholarCrossref
Bennett  P, Wilkinson  C, Turner  J,  et al.  Psychological factors associated with emotional responses to receiving genetic risk information.  J Genet Couns. 2008;17(3):234-241. doi:10.1007/s10897-007-9136-xPubMedGoogle ScholarCrossref
Bloom  JR, Stewart  SL, Chang  S, You  M.  Effects of a telephone counseling intervention on sisters of young women with breast cancer.  Prev Med. 2006;43(5):379-384. doi:10.1016/j.ypmed.2006.07.002PubMedGoogle ScholarCrossref
Bowen  DJ, Burke  W, Culver  JO, Press  N, Crystal  S.  Effects of counseling Ashkenazi Jewish women about breast cancer risk.  Cultur Divers Ethnic Minor Psychol. 2006;12(1):45-56. doi:10.1037/1099-9809.12.1.45PubMedGoogle ScholarCrossref
Brain  K, Parsons  E, Bennett  P, Cannings-John  R, Hood  K.  The evolution of worry after breast cancer risk assessment: 6-year follow-up of the TRACE study cohort.  Psychooncology. 2011;20(9):984-991.PubMedGoogle Scholar
Braithwaite  D, Sutton  S, Mackay  J, Stein  J, Emery  J.  Development of a risk assessment tool for women with a family history of breast cancer.  Cancer Detect Prev. 2005;29(5):433-439. doi:10.1016/j.cdp.2005.06.001PubMedGoogle ScholarCrossref
Fry  A, Cull  A, Appleton  S,  et al.  A randomised controlled trial of breast cancer genetics services in South East Scotland: psychological impact.  Br J Cancer. 2003;89(4):653-659. doi:10.1038/sj.bjc.6601170PubMedGoogle ScholarCrossref
Gurmankin  AD, Domchek  S, Stopfer  J, Fels  C, Armstrong  K.  Patients’ resistance to risk information in genetic counseling for BRCA1/2.  Arch Intern Med. 2005;165(5):523-529. doi:10.1001/archinte.165.5.523PubMedGoogle ScholarCrossref
Helmes  AW, Culver  JO, Bowen  DJ.  Results of a randomized study of telephone versus in-person breast cancer risk counseling.  Patient Educ Couns. 2006;64(1-3):96-103. doi:10.1016/j.pec.2005.12.002PubMedGoogle ScholarCrossref
Hopwood  P, Wonderling  D, Watson  M,  et al.  A randomised comparison of UK genetic risk counselling services for familial cancer: psychosocial outcomes.  Br J Cancer. 2004;91(5):884-892. doi:10.1038/sj.bjc.6602081PubMedGoogle ScholarCrossref
Kelly  KM, Senter  L, Leventhal  H, Ozakinci  G, Porter  K.  Subjective and objective risk of ovarian cancer in Ashkenazi Jewish women testing for BRCA1/2 mutations.  Patient Educ Couns. 2008;70(1):135-142. doi:10.1016/j.pec.2007.09.007PubMedGoogle ScholarCrossref
Matloff  ET, Moyer  A, Shannon  KM, Niendorf  KB, Col  NF.  Healthy women with a family history of breast cancer: impact of a tailored genetic counseling intervention on risk perception, knowledge, and menopausal therapy decision making.  J Womens Health (Larchmt). 2006;15(7):843-856. doi:10.1089/jwh.2006.15.843PubMedGoogle ScholarCrossref
Mikkelsen  EM, Sunde  L, Johansen  C, Johnsen  SP.  Risk perception among women receiving genetic counseling: a population-based follow-up study.  Cancer Detect Prev. 2007;31(6):457-464. doi:10.1016/j.cdp.2007.10.013PubMedGoogle ScholarCrossref
Mikkelsen  EM, Sunde  L, Johansen  C, Johnsen  SP.  Psychosocial consequences of genetic counseling: a population-based follow-up study.  Breast J. 2009;15(1):61-68. doi:10.1111/j.1524-4741.2008.00672.xPubMedGoogle ScholarCrossref
Pieterse  AH, Ausems  MG, Spreeuwenberg  P, van Dulmen  S.  Longer-term influence of breast cancer genetic counseling on cognitions and distress: smaller benefits for affected versus unaffected women.  Patient Educ Couns. 2011;85(3):425-431. doi:10.1016/j.pec.2011.01.017PubMedGoogle ScholarCrossref
Roshanai  AH, Rosenquist  R, Lampic  C, Nordin  K.  Does enhanced information at cancer genetic counseling improve counselees’ knowledge, risk perception, satisfaction and negotiation of information to at-risk relatives?—a randomized study.  Acta Oncol. 2009;48(7):999-1009. doi:10.1080/02841860903104137PubMedGoogle ScholarCrossref
Smerecnik  CM, Mesters  I, Verweij  E, de Vries  NK, de Vries  H.  A systematic review of the impact of genetic counseling on risk perception accuracy.  J Genet Couns. 2009;18(3):217-228. doi:10.1007/s10897-008-9210-zPubMedGoogle ScholarCrossref
Brain  K, Norman  P, Gray  J, Rogers  C, Mansel  R, Harper  P.  A randomized trial of specialist genetic assessment: psychological impact on women at different levels of familial breast cancer risk.  Br J Cancer. 2002;86(2):233-238. doi:10.1038/sj.bjc.6600051PubMedGoogle ScholarCrossref
Hopwood  P, Keeling  F, Long  A, Pool  C, Evans  G, Howell  A.  Psychological support needs for women at high genetic risk of breast cancer: some preliminary indicators.  Psychooncology. 1998;7(5):402-412. doi:10.1002/(SICI)1099-1611(1998090)7:5<402::AID-PON317>3.0.CO;2-XPubMedGoogle ScholarCrossref
Lerman  C, Schwartz  MD, Miller  SM, Daly  M, Sands  C, Rimer  BK.  A randomized trial of breast cancer risk counseling: interacting effects of counseling, educational level, and coping style.  Health Psychol. 1996;15(2):75-83. doi:10.1037/0278-6133.15.2.75PubMedGoogle ScholarCrossref
Lobb  EA, Butow  PN, Barratt  A,  et al.  Communication and information-giving in high-risk breast cancer consultations: influence on patient outcomes.  Br J Cancer. 2004;90(2):321-327. doi:10.1038/sj.bjc.6601502PubMedGoogle ScholarCrossref
Watson  M, Lloyd  S, Davidson  J,  et al.  The impact of genetic counselling on risk perception and mental health in women with a family history of breast cancer.  Br J Cancer. 1999;79(5-6):868-874. doi:10.1038/sj.bjc.6690139PubMedGoogle ScholarCrossref
Watson  M, Duvivier  V, Wade Walsh  M,  et al.  Family history of breast cancer: what do women understand and recall about their genetic risk?  J Med Genet. 1998;35(9):731-738. doi:10.1136/jmg.35.9.731PubMedGoogle ScholarCrossref
Livaudais-Toman  J, Karliner  LS, Tice  JA,  et al.  Impact of a primary care based intervention on breast cancer knowledge, risk perception and concern: a randomized, controlled trial.  Breast. 2015;24(6):758-766. doi:10.1016/j.breast.2015.09.009PubMedGoogle ScholarCrossref
Lerman  C, Hughes  C, Benkendorf  JL,  et al.  Racial differences in testing motivation and psychological distress following pretest education for BRCA1 gene testing.  Cancer Epidemiol Biomarkers Prev. 1999;8(4, pt 2):361-367.PubMedGoogle Scholar
Manchanda  R, Loggenberg  K, Sanderson  S,  et al.  Population testing for cancer predisposing BRCA1/BRCA2 mutations in the Ashkenazi-Jewish community: a randomized controlled trial.  J Natl Cancer Inst. 2014;107(1):379.PubMedGoogle Scholar
Julian-Reynier  C, Mancini  J, Mouret-Fourme  E,  et al.  Cancer risk management strategies and perceptions of unaffected women 5 years after predictive genetic testing for BRCA1/2 mutations.  Eur J Hum Genet. 2011;19(5):500-506. doi:10.1038/ejhg.2010.241PubMedGoogle ScholarCrossref
Lumish  HS, Steinfeld  H, Koval  C,  et al.  Impact of panel gene testing for hereditary breast and ovarian cancer on patients.  J Genet Couns. 2017;26(5):1116-1129. doi:10.1007/s10897-017-0090-yPubMedGoogle ScholarCrossref
Nelson  HD, Fu  R, McDonagh  M, Miller  LB, Pappas  M, Zakher  B.  Medication Use for the Risk Reduction of Primary Breast Cancer in Women: A Systematic Review for the US Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality; 2019.
Fisher  B, Costantino  JP, Wickerham  DL,  et al.  Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study.  J Natl Cancer Inst. 2005;97(22):1652-1662. doi:10.1093/jnci/dji372PubMedGoogle ScholarCrossref
Powles  TJ, Ashley  S, Tidy  A, Smith  IE, Dowsett  M.  Twenty-year follow-up of the Royal Marsden randomized, double-blinded tamoxifen breast cancer prevention trial.  J Natl Cancer Inst. 2007;99(4):283-290. doi:10.1093/jnci/djk050PubMedGoogle ScholarCrossref
Veronesi  U, Maisonneuve  P, Rotmensz  N,  et al; Italian Tamoxifen Study Group.  Tamoxifen for the prevention of breast cancer: late results of the Italian Randomized Tamoxifen Prevention Trial among women with hysterectomy.  J Natl Cancer Inst. 2007;99(9):727-737. doi:10.1093/jnci/djk154PubMedGoogle ScholarCrossref
Cuzick  J, Forbes  JF, Sestak  I,  et al; International Breast Cancer Intervention Study I Investigators.  Long-term results of tamoxifen prophylaxis for breast cancer—96-month follow-up of the randomized IBIS-I trial.  J Natl Cancer Inst. 2007;99(4):272-282. doi:10.1093/jnci/djk049PubMedGoogle ScholarCrossref
Lippman  ME, Cummings  SR, Disch  DP,  et al.  Effect of raloxifene on the incidence of invasive breast cancer in postmenopausal women with osteoporosis categorized by breast cancer risk.  Clin Cancer Res. 2006;12(17):5242-5247. doi:10.1158/1078-0432.CCR-06-0688PubMedGoogle ScholarCrossref
Grady  D, Cauley  JA, Geiger  MJ,  et al; Raloxifene Use for The Heart Trial Investigators.  Reduced incidence of invasive breast cancer with raloxifene among women at increased coronary risk.  J Natl Cancer Inst. 2008;100(12):854-861. doi:10.1093/jnci/djn153PubMedGoogle ScholarCrossref
Cuzick  J, Sestak  I, Forbes  JF,  et al; IBIS-II Investigators.  Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial.  Lancet. 2014;383(9922):1041-1048. doi:10.1016/S0140-6736(13)62292-8PubMedGoogle ScholarCrossref
Goss  PE, Ingle  JN, Alés-Martínez  JE,  et al; NCIC CTG MAP.3 Study Investigators.  Exemestane for breast-cancer prevention in postmenopausal women.  N Engl J Med. 2011;364(25):2381-2391. doi:10.1056/NEJMoa1103507PubMedGoogle ScholarCrossref
Sestak  I, Singh  S, Cuzick  J,  et al.  Changes in bone mineral density at 3 years in postmenopausal women receiving anastrozole and risedronate in the IBIS-II bone substudy: an international, double-blind, randomised, placebo-controlled trial  [published correction appears in Lancet Oncol. 2014;15(13):e587].  Lancet Oncol. 2014;15(13):1460-1468. doi:10.1016/S1470-2045(14)71035-6PubMedGoogle ScholarCrossref
Spagnolo  F, Sestak  I, Howell  A, Forbes  JF, Cuzick  J.  Anastrozole-induced carpal tunnel syndrome: results from the International Breast Cancer Intervention Study II prevention trial.  J Clin Oncol. 2016;34(2):139-143. doi:10.1200/JCO.2015.63.4972PubMedGoogle ScholarCrossref
Maunsell  E, Goss  PE, Chlebowski  RT,  et al.  Quality of life in MAP.3 (Mammary Prevention 3): a randomized, placebo-controlled trial evaluating exemestane for prevention of breast cancer.  J Clin Oncol. 2014;32(14):1427-1436. doi:10.1200/JCO.2013.51.2483PubMedGoogle ScholarCrossref
Vogel  VG, Costantino  JP, Wickerham  DL,  et al; National Surgical Adjuvant Breast and Bowel Project.  Update of the National Surgical Adjuvant Breast and Bowel Project Study of Tamoxifen and Raloxifene (STAR) P-2 Trial: Preventing breast cancer.  Cancer Prev Res (Phila). 2010;3(6):696-706. doi:10.1158/1940-6207.CAPR-10-0076PubMedGoogle ScholarCrossref
Domchek  SM, Friebel  TM, Singer  CF,  et al.  Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality.  JAMA. 2010;304(9):967-975. doi:10.1001/jama.2010.1237PubMedGoogle ScholarCrossref
Hartmann  LC, Schaid  DJ, Woods  JE,  et al.  Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer.  N Engl J Med. 1999;340(2):77-84. doi:10.1056/NEJM199901143400201PubMedGoogle ScholarCrossref
Hartmann  LC, Sellers  TA, Schaid  DJ,  et al.  Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers.  J Natl Cancer Inst. 2001;93(21):1633-1637. doi:10.1093/jnci/93.21.1633PubMedGoogle ScholarCrossref
Evans  DG, Baildam  AD, Anderson  E,  et al.  Risk reducing mastectomy: outcomes in 10 European centres.  J Med Genet. 2009;46(4):254-258. doi:10.1136/jmg.2008.062232PubMedGoogle ScholarCrossref
Skytte  AB, Crüger  D, Gerster  M,  et al.  Breast cancer after bilateral risk-reducing mastectomy.  Clin Genet. 2011;79(5):431-437. doi:10.1111/j.1399-0004.2010.01604.xPubMedGoogle ScholarCrossref
Heemskerk-Gerritsen  BA, Menke-Pluijmers  MB, Jager  A,  et al.  Substantial breast cancer risk reduction and potential survival benefit after bilateral mastectomy when compared with surveillance in healthy BRCA1 and BRCA2 mutation carriers: a prospective analysis.  Ann Oncol. 2013;24(8):2029-2035. doi:10.1093/annonc/mdt134PubMedGoogle ScholarCrossref
Flippo-Morton  T, Walsh  K, Chambers  K,  et al.  Surgical decision making in the BRCA-positive population: institutional experience and comparison with recent literature.  Breast J. 2016;22(1):35-44. doi:10.1111/tbj.12521PubMedGoogle ScholarCrossref
Kramer  JL, Velazquez  IA, Chen  BE, Rosenberg  PS, Struewing  JP, Greene  MH.  Prophylactic oophorectomy reduces breast cancer penetrance during prospective, long-term follow-up of BRCA1 mutation carriers.  J Clin Oncol. 2005;23(34):8629-8635. doi:10.1200/JCO.2005.02.9199PubMedGoogle ScholarCrossref
Olson  JE, Sellers  TA, Iturria  SJ, Hartmann  LC.  Bilateral oophorectomy and breast cancer risk reduction among women with a family history.  Cancer Detect Prev. 2004;28(5):357-360. doi:10.1016/j.cdp.2004.03.003PubMedGoogle ScholarCrossref
Struewing  JP, Watson  P, Easton  DF, Ponder  BA, Lynch  HT, Tucker  MA.  Prophylactic oophorectomy in inherited breast/ovarian cancer families.  J Natl Cancer Inst Monogr. 1995;(17):33-35.PubMedGoogle Scholar
Mavaddat  N, Peock  S, Frost  D,  et al; EMBRACE.  Cancer risks for BRCA1 and BRCA2 mutation carriers: results from prospective analysis of EMBRACE.  J Natl Cancer Inst. 2013;105(11):812-822. doi:10.1093/jnci/djt095PubMedGoogle ScholarCrossref
Shah  P, Rosen  M, Stopfer  J,  et al.  Prospective study of breast MRI in BRCA1 and BRCA2 mutation carriers: effect of mutation status on cancer incidence.  Breast Cancer Res Treat. 2009;118(3):539-546. doi:10.1007/s10549-009-0475-1PubMedGoogle ScholarCrossref
Rebbeck  TR, Lynch  HT, Neuhausen  SL,  et al; Prevention and Observation of Surgical End Points Study Group.  Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations.  N Engl J Med. 2002;346(21):1616-1622. doi:10.1056/NEJMoa012158PubMedGoogle ScholarCrossref
Kotsopoulos  J, Huzarski  T, Gronwald  J,  et al; Hereditary Breast Cancer Clinical Study Group.  Bilateral oophorectomy and breast cancer risk in BRCA1 and BRCA2 mutation carriers  [published online September 6, 2016].  J Natl Cancer Inst. 2016;109(1). doi:10.1093/jnci/djw177PubMedGoogle Scholar
Heemskerk-Gerritsen  BA, Seynaeve  C, van Asperen  CJ,  et al; Hereditary Breast and Ovarian Cancer Research Group Netherlands.  Breast cancer risk after salpingo-oophorectomy in healthy BRCA1/2 mutation carriers: revisiting the evidence for risk reduction  [published online March 18, 2015].  J Natl Cancer Inst. 2015;107(5):djv033. doi:10.1093/jnci/djv033PubMedGoogle Scholar
Lieberman  S, Tomer  A, Ben-Chetrit  A,  et al.  Population screening for BRCA1/BRCA2 founder mutations in Ashkenazi Jews: proactive recruitment compared with self-referral.  Genet Med. 2017;19(7):754-762. doi:10.1038/gim.2016.182PubMedGoogle ScholarCrossref
Smith  KR, West  JA, Croyle  RT, Botkin  JR.  Familial context of genetic testing for cancer susceptibility: moderating effect of siblings’ test results on psychological distress one to two weeks after BRCA1 mutation testing.  Cancer Epidemiol Biomarkers Prev. 1999;8(4, pt 2):385-392.PubMedGoogle Scholar
Dagan  E, Shochat  T.  Quality of life in asymptomatic BRCA1/2 mutation carriers.  Prev Med. 2009;48(2):193-196. doi:10.1016/j.ypmed.2008.11.007PubMedGoogle ScholarCrossref
van Dijk  S, Timmermans  DR, Meijers-Heijboer  H, Tibben  A, van Asperen  CJ, Otten  W.  Clinical characteristics affect the impact of an uninformative DNA test result: the course of worry and distress experienced by women who apply for genetic testing for breast cancer.  J Clin Oncol. 2006;24(22):3672-3677. doi:10.1200/JCO.2005.03.7259PubMedGoogle ScholarCrossref
Metcalfe  KA, Mian  N, Enmore  M,  et al.  Long-term follow-up of Jewish women with a BRCA1 and BRCA2 mutation who underwent population genetic screening.  Breast Cancer Res Treat. 2012;133(2):735-740. doi:10.1007/s10549-011-1941-0PubMedGoogle ScholarCrossref
Meiser  B, Butow  P, Friedlander  M,  et al.  Psychological impact of genetic testing in women from high-risk breast cancer families.  Eur J Cancer. 2002;38(15):2025-2031. doi:10.1016/S0959-8049(02)00264-2PubMedGoogle ScholarCrossref
Andrews  L, Meiser  B, Apicella  C, Tucker  K.  Psychological impact of genetic testing for breast cancer susceptibility in women of Ashkenazi Jewish background: a prospective study.  Genet Test. 2004;8(3):240-247. doi:10.1089/gte.2004.8.240PubMedGoogle ScholarCrossref
Foster  C, Watson  M, Eeles  R,  et al; Psychosocial Study Collaborators.  Predictive genetic testing for BRCA1/2 in a UK clinical cohort: three-year follow-up.  Br J Cancer. 2007;96(5):718-724. doi:10.1038/sj.bjc.6603610PubMedGoogle ScholarCrossref
Low  CA, Bower  JE, Kwan  L, Seldon  J.  Benefit finding in response to BRCA1/2 testing.  Ann Behav Med. 2008;35(1):61-69. doi:10.1007/s12160-007-9004-9PubMedGoogle ScholarCrossref
Arver  B, Haegermark  A, Platten  U, Lindblom  A, Brandberg  Y.  Evaluation of psychosocial effects of pre-symptomatic testing for breast/ovarian and colon cancer pre-disposing genes: a 12-month follow-up.  Fam Cancer. 2004;3(2):109-116. doi:10.1023/B:FAME.0000039863.89137.f9PubMedGoogle ScholarCrossref
Ertmański  S, Metcalfe  K, Trempała  J,  et al.  Identification of patients at high risk of psychological distress after BRCA1 genetic testing.  Genet Test Mol Biomarkers. 2009;13(3):325-330. doi:10.1089/gtmb.2008.0126PubMedGoogle ScholarCrossref
Reichelt  JG, Møller  P, Heimdal  K, Dahl  AA.  Psychological and cancer-specific distress at 18 months post-testing in women with demonstrated BRCA1 mutations for hereditary breast/ovarian cancer.  Fam Cancer. 2008;7(3):245-254. doi:10.1007/s10689-008-9182-zPubMedGoogle ScholarCrossref
Reichelt  JG, Heimdal  K, Møller  P, Dahl  AA.  BRCA1 testing with definitive results: a prospective study of psychological distress in a large clinic-based sample.  Fam Cancer. 2004;3(1):21-28. doi:10.1023/B:FAME.0000026820.32469.4aPubMedGoogle ScholarCrossref
Geirdal  AO, Dahl  AA.  The relationship between coping strategies and anxiety in women from families with familial breast-ovarian cancer in the absence of demonstrated mutations.  Psychooncology. 2008;17(1):49-57. doi:10.1002/pon.1198PubMedGoogle ScholarCrossref
Geirdal  AO, Reichelt  JG, Dahl  AA,  et al.  Psychological distress in women at risk of hereditary breast/ovarian or HNPCC cancers in the absence of demonstrated mutations.  Fam Cancer. 2005;4(2):121-126. doi:10.1007/s10689-004-7995-yPubMedGoogle ScholarCrossref
Le-Petross  HT, Whitman  GJ, Atchley  DP,  et al.  Effectiveness of alternating mammography and magnetic resonance imaging for screening women with deleterious BRCA mutations at high risk of breast cancer.  Cancer. 2011;117(17):3900-3907. doi:10.1002/cncr.25971PubMedGoogle ScholarCrossref
Kriege  M, Brekelmans  CT, Boetes  C,  et al; Dutch MRI Screening (MRISC) Study Group.  Differences between first and subsequent rounds of the MRISC breast cancer screening program for women with a familial or genetic predisposition.  Cancer. 2006;106(11):2318-2326. doi:10.1002/cncr.21863PubMedGoogle ScholarCrossref
Bourne  TH, Campbell  S, Reynolds  KM,  et al.  Screening for early familial ovarian cancer with transvaginal ultrasonography and colour blood flow imaging.  BMJ. 1993;306(6884):1025-1029. doi:10.1136/bmj.306.6884.1025PubMedGoogle ScholarCrossref
Hermsen  BB, Olivier  RI, Verheijen  RH,  et al.  No efficacy of annual gynaecological screening in BRCA1/2 mutation carriers; an observational follow-up study.  Br J Cancer. 2007;96(9):1335-1342. doi:10.1038/sj.bjc.6603725PubMedGoogle ScholarCrossref
Spiegel  TN, Esplen  MJ, Hill  KA, Wong  J, Causer  PA, Warner  E.  Psychological impact of recall on women with BRCA mutations undergoing MRI surveillance.  Breast. 2011;20(5):424-430. doi:10.1016/j.breast.2011.04.004PubMedGoogle ScholarCrossref
Nelson  HD, Fu  R, Griffin  JC, Nygren  P, Smith  ME, Humphrey  L.  Systematic review: comparative effectiveness of medications to reduce risk for primary breast cancer.  Ann Intern Med. 2009;151(10):703-715. doi:10.7326/0000605-200911170-00147PubMedGoogle ScholarCrossref
Nelson  HD, Smith  ME, Griffin  JC, Fu  R.  Use of medications to reduce risk for primary breast cancer: a systematic review for the U.S. Preventive Services Task Force.  Ann Intern Med. 2013;158(8):604-614. doi:10.7326/0003-4819-158-8-201304160-00005PubMedGoogle ScholarCrossref
Arver  B, Isaksson  K, Atterhem  H,  et al.  Bilateral prophylactic mastectomy in Swedish women at high risk of breast cancer: a national survey.  Ann Surg. 2011;253(6):1147-1154. doi:10.1097/SLA.0b013e318214b55aPubMedGoogle ScholarCrossref
Heemskerk-Gerritsen  BA, Brekelmans  CT, Menke-Pluymers  MB,  et al.  Prophylactic mastectomy in BRCA1/2 mutation carriers and women at risk of hereditary breast cancer: long-term experiences at the Rotterdam Family Cancer Clinic.  Ann Surg Oncol. 2007;14(12):3335-3344. doi:10.1245/s10434-007-9449-xPubMedGoogle ScholarCrossref
Alamouti  R, Hachach-Haram  N, Farhadi  J.  Multidisciplinary management of risk-reducing mastectomy and immediate reconstruction: treatment algorithm and patient satisfaction.  J Plast Reconstr Aesthet Surg. 2015;38(5):385-390.Google Scholar
Nurudeen  S, Guo  H, Chun  Y,  et al.  Patient experience with breast reconstruction process following bilateral mastectomy in BRCA mutation carriers.  Am J Surg. 2017;214(4):687-694. doi:10.1016/j.amjsurg.2017.06.017PubMedGoogle ScholarCrossref
den Heijer  M, Seynaeve  C, Timman  R,  et al.  Body image and psychological distress after prophylactic mastectomy and breast reconstruction in genetically predisposed women: a prospective long-term follow-up study.  Eur J Cancer. 2012;48(9):1263-1268. doi:10.1016/j.ejca.2011.10.020PubMedGoogle ScholarCrossref
Gopie  JP, Mureau  MA, Seynaeve  C,  et al.  Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer.  Fam Cancer. 2013;12(3):479-487. doi:10.1007/s10689-012-9588-5PubMedGoogle ScholarCrossref
Isern  AE, Tengrup  I, Loman  N, Olsson  H, Ringberg  A.  Aesthetic outcome, patient satisfaction, and health-related quality of life in women at high risk undergoing prophylactic mastectomy and immediate breast reconstruction.  J Plast Reconstr Aesthet Surg. 2008;61(10):1177-1187. doi:10.1016/j.bjps.2007.08.006PubMedGoogle ScholarCrossref
Stefanek  ME, Helzlsouer  KJ, Wilcox  PM, Houn  F.  Predictors of and satisfaction with bilateral prophylactic mastectomy.  Prev Med. 1995;24(4):412-419. doi:10.1006/pmed.1995.1066PubMedGoogle ScholarCrossref
Brandberg  Y, Sandelin  K, Erikson  S,  et al.  Psychological reactions, quality of life, and body image after bilateral prophylactic mastectomy in women at high risk for breast cancer: a prospective 1-year follow-up study.  J Clin Oncol. 2008;26(24):3943-3949. doi:10.1200/JCO.2007.13.9568PubMedGoogle ScholarCrossref
Gahm  J, Wickman  M, Brandberg  Y.  Bilateral prophylactic mastectomy in women with inherited risk of breast cancer—prevalence of pain and discomfort, impact on sexuality, quality of life and feelings of regret two years after surgery.  Breast. 2010;19(6):462-469. doi:10.1016/j.breast.2010.05.003PubMedGoogle ScholarCrossref
Brandberg  Y, Arver  B, Johansson  H, Wickman  M, Sandelin  K, Liljegren  A.  Less correspondence between expectations before and cosmetic results after risk-reducing mastectomy in women who are mutation carriers: a prospective study.  Eur J Surg Oncol. 2012;38(1):38-43. doi:10.1016/j.ejso.2011.10.010PubMedGoogle ScholarCrossref
Wasteson  E, Sandelin  K, Brandberg  Y, Wickman  M, Arver  B.  High satisfaction rate ten years after bilateral prophylactic mastectomy—a longitudinal study.  Eur J Cancer Care (Engl). 2011;20(4):508-513. doi:10.1111/j.1365-2354.2010.01204.xPubMedGoogle ScholarCrossref
Metcalfe  KA, Esplen  MJ, Goel  V, Narod  SA.  Psychosocial functioning in women who have undergone bilateral prophylactic mastectomy.  Psychooncology. 2004;13(1):14-25. doi:10.1002/pon.726PubMedGoogle ScholarCrossref
Finch  A, Metcalfe  KA, Chiang  JK,  et al.  The impact of prophylactic salpingo-oophorectomy on menopausal symptoms and sexual function in women who carry a BRCA mutation.  Gynecol Oncol. 2011;121(1):163-168. doi:10.1016/j.ygyno.2010.12.326PubMedGoogle ScholarCrossref
Kenkhuis  MJ, de Bock  GH, Elferink  PO,  et al.  Short-term surgical outcome and safety of risk reducing salpingo-oophorectomy in BRCA1/2 mutation carriers.  Maturitas. 2010;66(3):310-314. doi:10.1016/j.maturitas.2010.03.018PubMedGoogle ScholarCrossref
Michelsen  TM, Dørum  A, Tropé  CG, Fosså  SD, Dahl  AA.  Fatigue and quality of life after risk-reducing salpingo-oophorectomy in women at increased risk for hereditary breast-ovarian cancer.  Int J Gynecol Cancer. 2009;19(6):1029-1036. doi:10.1111/IGC.0b013e3181a83cd5PubMedGoogle ScholarCrossref
Bresser  PJ, Seynaeve  C, Van Gool  AR,  et al.  The course of distress in women at increased risk of breast and ovarian cancer due to an (identified) genetic susceptibility who opt for prophylactic mastectomy and/or salpingo-oophorectomy.  Eur J Cancer. 2007;43(1):95-103. doi:10.1016/j.ejca.2006.09.009PubMedGoogle ScholarCrossref
Borreani  C, Manoukian  S, Bianchi  E,  et al.  The psychological impact of breast and ovarian cancer preventive options in BRCA1 and BRCA2 mutation carriers.  Clin Genet. 2014;85(1):7-15. doi:10.1111/cge.12298PubMedGoogle ScholarCrossref
Finch  A, Narod  SA.  Quality of life and health status after prophylactic salpingo-oophorectomy in women who carry a BRCA mutation: a review.  Maturitas. 2011;70(3):261-265. doi:10.1016/j.maturitas.2011.08.001PubMedGoogle ScholarCrossref
U.S. Preventive Services Task Force.  Genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility: recommendation statement.  Ann Intern Med. 2005;143(5):355-361. doi:10.7326/0003-4819-143-5-200509060-00011PubMedGoogle ScholarCrossref
American College of Medical Genetics.  Genetic Susceptibility to Breast and Ovarian Cancer: Assessment, Counseling, and Testing Guidelines. Bethesda, MD: American College of Medical Genetics; 1999.
American Society of Clinical Oncology.  Statement of the American Society of Clinical Oncology: genetic testing for cancer susceptibility, adopted on February 20, 1996.  J Clin Oncol. 1996;14(5):1730-1736. doi:10.1200/JCO.1996.14.5.1730PubMedGoogle ScholarCrossref
 Committee opinion no. 634: hereditary cancer syndromes and risk assessment.  Obstet Gynecol. 2015;125(6):1538-1543. doi:10.1097/01.AOG.0000466373.71146.51PubMedGoogle ScholarCrossref
Lancaster  JM, Powell  CB, Chen  LM, Richardson  DL; SGO Clinical Practice Committee.  Society of Gynecologic Oncology statement on risk assessment for inherited gynecologic cancer predispositions.  Gynecol Oncol. 2015;136(1):3-7. doi:10.1016/j.ygyno.2014.09.009PubMedGoogle ScholarCrossref
American Society of Breast Surgeons (ASBrS). Consensus Guideline on Genetic Testing for Hereditary Breast Cancer. ASBrS website. Accessed July 3, 2019.
National Institute for Health and Care Excellence (NICE). Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer. NICE website. Published June 2013. Accessed July 3, 2019.
Paluch-Shimon  S, Cardoso  F, Sessa  C,  et al; ESMO Guidelines Committee.  Prevention and screening in BRCA mutation carriers and other breast/ovarian hereditary cancer syndromes: ESMO clinical practice guidelines for cancer prevention and screening.  Ann Oncol. 2016;27(suppl 5):v103-v110. doi:10.1093/annonc/mdw327PubMedGoogle ScholarCrossref
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