{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:21:07Z","timestamp":1787761267278,"version":"build-2784847793"},"reference-count":39,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n \n Young\n BRCA<\/jats:italic>\n carriers may undergo breast-conserving surgery (BCS) or mastectomy with or without contralateral risk-reducing mastectomy at the time of an index breast cancer diagnosis. A variety of factors may influence surgical decision-making.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n To explore surgical patterns of care and factors associated with uptake of bilateral mastectomy among affected\n BRCA1<\/jats:italic>\n or\n BRCA2<\/jats:italic>\n (\n BRCA1\/2<\/jats:italic>\n ) carriers diagnosed with early-onset breast cancer.\n <\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n \n The BRCA BCY Collaboration is an international, hospital-based retrospective cohort study conducted at 109 centers across 5 continents. Women aged 40 years or younger with germline pathogenic or likely pathogenic variants in\n BRCA1\/2<\/jats:italic>\n who were diagnosed between January 1, 2000, and December 31, 2020, with invasive stage I to III breast cancer were included. Data were collected between January 2022 and June 2024, and analyses were performed between May 21 and 28, 2025.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measures<\/jats:title>\n The main outcome was the evaluation of surgical management as primary treatment for a first diagnosis of invasive breast cancer, defined as BCS, unilateral mastectomy, or bilateral mastectomy.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 5660 eligible\n BRCA1\/2<\/jats:italic>\n carriers, 4715 women (median [IQR] age, 35 [31-38] years) had unilateral stage I to III breast cancer with surgical treatment details available. In the cohort, 1805 patients (38.3%) underwent BCS, 1752 (37.2%) underwent unilateral mastectomy, and 1158 (24.6%) underwent bilateral mastectomy. The proportion of\n BRCA1\/2<\/jats:italic>\n carriers undergoing BCS decreased over the study period (55.7% [49 of 88] in 2000 vs 27.0% [82 of 304] in 2020), whereas the use of bilateral mastectomy significantly increased (8.0% [7 of 88] in 2000 vs 44.4% [135 of 304] in 2020). Bilateral mastectomy was more common in women who had genetic testing performed before (248 of 435 [57.0%]) or within 6 months (729 of 1892 [38.5%]) of a breast cancer diagnosis compared with those tested after diagnosis (111 of 2167 [5.1%]). On multivariable analysis, compared with those tested after diagnosis, earlier genetic testing was the factor most strongly associated with bilateral mastectomy receipt (testing prior to diagnosis: adjusted odds ratio, 20.72 [95% CI, 15.27-28.13]; testing at diagnosis: adjusted odds ratio, 6.83 [95% CI, 5.39-8.66]). In subgroup analyses, including 2327 patients who had genetic testing performed before or within 6 months of diagnosis, 977 (42.0%) underwent bilateral mastectomy, with the lowest rates reported in Asia and Africa (130 of 499 [26.1%]) and the highest rates reported in North America (233 of 351 [66.4%]).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n \n The findings of this cohort study of young\n BRCA1\/2<\/jats:italic>\n carriers suggest that geographic region and timing of genetic testing were the factors most strongly associated with surgical management.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.30856","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:30:35Z","timestamp":1787758235000},"page":"e2630856","source":"Crossref","is-referenced-by-count":0,"title":["Surgical Management of Early-Onset Breast Cancer Among Young\n BRCA1<\/i>\n and\n BRCA2<\/i>\n Carriers"],"prefix":"10.1001","volume":"9","author":[{"given":"Stephanie M.","family":"Wong","sequence":"first","affiliation":[{"name":"Department of Surgery and Oncology, McGill University Medical School, Montreal, Quebec, Canada"},{"name":"Stroll Cancer Prevention Centre, Jewish General Hospital Segal Cancer Centre, Montreal, Quebec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Blondeaux","sequence":"additional","affiliation":[{"name":"AOM - IRCCS Ospedale Policlinico San Martino, Clinical Trial Unit, U.O. 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