Uptake of risk-reducing surgery in unaffected women at high risk of breast and ovarian cancer is risk, age, and time dependent.

PURPOSE: The uptake of risk-reducing surgery in women at increased risk of breast and ovarian cancer is highly variable between countries and centers within countries. We have investigated the rate, timing, and age of uptake of surgery in the northwest of England to report the results after up to 7 years in a Regional Genetics center. METHODS: Uptake was documented in 211 known unaffected BRCA1/2 mutation carriers from 509 families and in 3,515 women at >25% lifetime risk of breast cancer without known mutations. RESULTS: Of the 211 mutation carriers, 40% opted for bilateral risk-reducing mastectomy (BRRM) and 45% underwent bilateral risk-reducing salpingo-oophorectomy (BRRSPO). Uptake of BRRM was significantly related to lifetime risk and age but continued over several years. In women not known to carry a BRCA mutation, 6.4% of women at 40% to 45% lifetime risk, 2.5% of women at 33% to 39% lifetime risk, and 1.8% of women at 25% to 32% lifetime risk underwent BRRM (P < 0.005). BRRSPO uptake was greater in BRCA1 (52%) than BRCA2 (28%) carriers but in both groups tended to occur within the first 2 years after gene test (except in the youngest age group) and in women between the ages of 35 and 45. CONCLUSION: To truly assess the uptake of risk-reducing surgery, longer-term follow-up is necessary particularly in younger women who are likely to delay BRRSPO. Careful risk counseling does seem to influence women's decisions for surgery, although the effect is not immediate.

Musculotendinous anomalies in musician and nonmusician hands.

Musculoskeletal abnormalities of musicians' hands and upper extremities are well-recognized and potentially career-threatening problems. Of the many types of potentiality problematic musculoskeletal disorders that could be assessed, this study focused on joint instability and musculotendinous anomalies. For this study, the hands of 92 music students were compared with the hands of 64 nonmusician control subjects. Flexor anomalies were observed much more frequently than extensor musculotendinous anomalies; clinical evidence of the Linburg-Comstock anomaly was noted for 60 to 70 percent of subjects in both groups. Further analysis of the Linburg-Comstock anomaly demonstrated that the sites of pain among test-positive subjects were variable, test positivity was more frequent in the left hand and among string players, and test positivity tended to decrease from the radial side to the ulnar side of the hand. There were only two definite extensor musculotendinous anomalies (1.3 percent), and both involved a subluxating extensor mechanism affecting the little fingers. Forty-three percent of all subjects exhibited a degree of instability affecting the joints of their hands.