Coordinated prophylactic surgical management for women with hereditary breast-ovarian cancer syndrome

High risk women for breast and ovarian cancer who underwent coordinated PM and BSO were included in this study. Clinical characteristics and surgical and oncologic outcomes were retrospectively reviewed.Twelve patients underwent coordinated PM and BSO. Ten had history of previous breast cancer. Autologous breast reconstruction was performed in ten patients. The mean age at surgery was 43 (range 34–65). Mean operating time was 9.3 hours (range 3–16) with a mean postoperative hospitalization of 5.4 days (range 4–8). Intraoperatively, there were no major surgical complications. Postoperatively, one patient developed an abdominal wound dehiscence, another reoperation for flap congestion; one had umbilical superficial epidermolysis, and one patient developed aspiration pneumonia. At a mean follow-up of 84 months, 10 of patients were cancer-free. Although no patients developed a new primary cancer, two developed a distant recurrence.Coordinated PM and BSO is a feasible procedure with acceptable morbidity in selected high-risk patients that desire to undergo surgery at one operative setting.Women with BRCA1 or BRCA2 mutation have a substantially increased risk of breast and ovarian cancer compared with the general population [1]. Breast cancer due to a hereditary cause is about 5 to 10% of all malignant breast disease and 25 to 40% of breast cancers that occur in women younger than 35 years old. Cumulative lifetime risk (to 70 years of age) for invasive breast cancer in women with BRCA1 and BRCA2 mutation is 40 to 85% and for invasive epithelial ovarian cancer is 15 to 65% [1-4]. Women who are BRCA1/2 mutation carriers also have a 26–40% risk of contralateral breast cancer in 10 years [5,6].Currently, management strategies for high-risk women include intense clinical follow up (every 3–6 months clinical breast exams and annual breast magnetic resonance imaging starting at 25 years of age, as well as gynecologic cancer screening with twice-yearly transvaginal ultrasound and