Cancer risks in women from BRCA-negative hereditary breast and ovarian cancer families

significantly more likely to use additional testing in hysterectomy vs.intact uterus patients (33% vs. 24%, P= 0.02). CA-125 and ultrasoundwere the most common additional post-RRSO surveillance techniquesin patients with an intact uterus (18%) while CA-125 surveillance wasmost common in hysterectomy patients (27%).Conclusions: Current RRSO practice routinely incorporates pelvicwashings, serial sectioning, and minimally invasive approaches.Concomitant hysterectomy is frequently performed, especially inpatients who plan to use HRT or have used tamoxifen. Manyrespondents felt that BRCA mutations may increase uterine cancerrisk. There was no consensus regarding the need or specific practicefor surveillance after RRSO.

doi:10.1016/j.ygyno.2013.04.306

248Comparing coordinated versus sequential salpingo-oophorectomyfor BRCA1 and BRCA2 mutation carriers with breast cancerJ. Chapman1, A. Panighetti2, S. Hwang3, B. Crawford4, B. Powell5, J.Chan4, L. Chen4. 1University of California San Francisco, San Francisco,CA, 2University of Washington Medical Center, Seattle, WA, 3DukeUniversity Medical Center, Durham, NC, 4UCSF Helen Diller FamilyComprehensive Cancer Center, San Francisco, CA, 5Kaiser Permanente,San Francisco, CA.

Objective: Women with breast cancer who carry BRCA1 or BRCA2(BRCA1/2) mutations must also consider risk-reducing salpingo-oophorectomy (RRSO) and how to coordinate this procedure withtheir breast cancer surgery. This retrospective study investigatedthe factors that contribute to a patient’s decision to havecoordinated vs. sequential surgery and compared the surgicaloutcomes of each.Methods: We queried our Cancer Risk Program database forpatients who had breast cancer and a known BRCA1/2 mutationprior to undergoing breast surgery. Women who chose concurrentRRSO at the time of breast surgery were compared to those who didnot.Results: Therewere 47patientswho knew theirmutation carrier statusbefore undergoing breast cancer surgery. Of these, 27 (57%) chosecoordinated surgeries, 12 (26%) underwent sequential surgeries, and 8(17%) elected against RRSO with a median follow-up time of 3.5 years(range, 1.4-11.9 years). Patients who elected coordinated surgery were4.4 years older than their sequential peers and 10 years older than theirnon-RRSO peers (P= 0.02). There were no significant differences inmedical comorbidities or use of neoadjuvant therapy among the 3groups. Total operating time was significantly different in each of thegroups; sequential surgery patients had the longest operating times(median = 8.43 hours), followed by combined surgery patients (med-ian = 7.42 hours) and patients who declined RRSO (med-ian = 3.97 hours) (P= 0.0007). Estimated blood loss and total lengthof hospital stay were not significantly different among groups. Therewere 8 minor postoperative complications in the coordinated groupand no complications in the sequential group (P= 0.04).Conclusions: Coordinating RRSO with breast surgery is associatedwith increased age and decreased total operating room time. Thesefindings are important factors to consider in counseling this uniquegroup of patients.

doi:10.1016/j.ygyno.2013.04.307

249Cancer risks in women from BRCA-negative hereditary breast andovarian cancer familiesK. Long, M. Pike, E. Otegbeye, A. Arnold, Z. Stadler, M. Robson, R.Barakat, K. Offit, D. Chi, N. Kauff. Memorial Sloan-Kettering CancerCenter, New York, NY.

Objective: While the cancer risks associated with BRCA mutationsare wellcharacterized, there are limited data to guide the counselingand management of women with family histories suspicious forhereditary breast and ovarian cancer who are BRCAnegative(BRCAneg). The goal of this study was to prospectively determinethe incidence of new breast cancer (BC) and ovarian cancer (OC) inwomen from BRCAneg breast and ovarian cancer families.Methods: From 1/1/02 to 2/28/11, all women undergoingcounseling and testing for BRCA mutations at our institution wereoffered participation in an institutional review board-approvedprospective cohort study. For the current analysis, participants wereincluded if they personally had a diagnosis of either BC ≤ age60 years (yrs) or OC at any age, had at least one additional first- orsecond-degree female relative with BC ≤ age 60 yrs or OC at any age,and were BRCAneg. Pedigrees were reviewed and kindreds wereclassified as site-specific breast (SSB) or hereditary breast-ovary(HBO). Participants were contacted via mailed questionnaire andasked to report on new cancer diagnoses since genetic testing. Forwomen with prior BC, only the contralateral breast was consideredto be at risk. If a participant had bilateral mastectomy, bilateraloophorectomy, or bilateral BC prior to receipt of genetic testingresults, the relevant tissue was not considered to be at risk. For eachparticipant with tissue at risk, woman-years at risk were calculatedas the time from genetic testing to date of completion of thequestionnaire. Expected cancer incidence was determined usingage-specific SEER data. The rates of observed-to-expected cancerswere analyzed using a Poisson distribution events test.Results: Of 2,559 BRCAneg women ascertained during the studyperiod, 664 met the personal and family history inclusion criteria.Follow-up questionnaires were completed by 419 (63%) participantsa median of 5.3 years after genetic testing. Among 320 women withbreast tissue at risk, there were 13 new BC in SSB kindreds (3.76expected, P b 0.001) and 2 new BC in HBO kindreds (1.46 expected,P= 0.43) (Table). Among 347 women with ovarian tissue at risk,there were 0 new OC in SSB kindreds (0.45 expected), and 2 new OCin HBO kindreds (expected 0.10, P = 0.005).Conclusions: Affected women from BRCAneg SSB kindreds wereconfirmed to have an increased rate of new BC but not OC.Additionally, these results suggest that BRCAneg women from HBOkindreds have an increased risk of OC, but not BC.

Table. Rate of Observed-to-Expected New Cancers.

doi:10.1016/j.ygyno.2013.04.308

Abstracts / Gynecologic Oncology 130 (2013) e1–e169 e105