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We examined risk\u2010reducing surgeries in unaffected individuals tested for hereditary cancer susceptibly between 2010 and 2018 in the Kaiser Permanente Northwest health system.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We used an internal genetic testing database to create a cohort of individuals who received tests including one or more high\u2010penetrance hereditary cancer susceptibility gene. We then identified, after testing, bilateral mastectomy, bilateral salpingo\u2010oophorectomy (BSO), and total hysterectomy procedures in electronic health record and claims data through 2019. We describe surgery utilization by genetic test results and National Comprehensive Cancer Network (NCCN) guidelines.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cohort included 1020 individuals, 16% with pathogenic\/likely pathogenic (P\/LP) variants in one or more of the following genes: <jats:italic>BRCA1, BRCA2, CHEK2, APC, MUTYH, ATM, MSH2, PALB2, BRIP1, MLH1, MSH6, EPCAM, FLCN, RAD51C, RAD51D,<\/jats:italic> or <jats:italic>TP53<\/jats:italic>. Among individuals with P\/LP variants making them candidates for mastectomy, BSO, or hysterectomy per NCCN guidelines, 34% (33\/97), 24% (23\/94), and 8% (1\/12), respectively, underwent surgery during follow\u2010up. Fifty\u2010three percent (18\/37) of hysterectomies were among <jats:italic>APC, BRCA1<\/jats:italic>, and <jats:italic>BRCA2<\/jats:italic> P\/LP variant heterozygotes, typically concurrent with BSO. Three individuals with variants of uncertain significance (only) and 22 with negative results had prophylactic surgery after genetic testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Uptake of risk\u2010reducing surgery following usual care genetic testing appears to be lower than in studies that actively recruit high\u2010risk patients and provide testing and follow\u2010up care in specialized settings. Factors in addition to genetic test results and NCCN guidelines motivate prophylactic surgery use and deserve further study.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.34349","type":"journal-article","created":{"date-parts":[[2022,6,9]],"date-time":"2022-06-09T12:44:56Z","timestamp":1654778696000},"page":"3090-3098","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Risk\u2010reducing surgery in unaffected individuals receiving cancer genetic testing in an integrated health care system"],"prefix":"10.1002","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5461-6298","authenticated-orcid":false,"given":"Sarah","family":"Knerr","sequence":"first","affiliation":[{"name":"School of Public Health University of Washington  Washington Seattle USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boya","family":"Guo","sequence":"additional","affiliation":[{"name":"School of Public Health University of Washington  Washington Seattle USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1097-9171","authenticated-orcid":false,"given":"Kathleen F.","family":"Mittendorf","sequence":"additional","affiliation":[{"name":"Department of Translational and Applied Genomics Center for Health Research, Kaiser Permanente Northwest  Oregon Portland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6691-3740","authenticated-orcid":false,"given":"Heather Spencer","family":"Feigelson","sequence":"additional","affiliation":[{"name":"Institute for Health Research Kaiser Permanente  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian J.","family":"Gilmore","sequence":"additional","affiliation":[{"name":"Department of Translational and Applied Genomics Center for Health Research, Kaiser Permanente Northwest  Oregon Portland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail P.","family":"Jarvik","sequence":"additional","affiliation":[{"name":"School of Medicine University of Washington  Washington Seattle USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tia L.","family":"Kauffman","sequence":"additional","affiliation":[{"name":"Center for Health Research Kaiser Permanente Northwest  Oregon Portland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Keast","sequence":"additional","affiliation":[{"name":"Center for Health Research Kaiser Permanente Northwest  Oregon Portland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frances L.","family":"Lynch","sequence":"additional","affiliation":[{"name":"Center for Health Research Kaiser Permanente Northwest  Oregon Portland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin R.","family":"Muessig","sequence":"additional","affiliation":[{"name":"Department of Translational and Applied Genomics Center for Health Research, Kaiser Permanente Northwest  Oregon Portland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Okuyama","sequence":"additional","affiliation":[{"name":"Division of Oncology Denver Health and Hospital Authority  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David L.","family":"Veenstra","sequence":"additional","affiliation":[{"name":"The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy University of Washington  Washington Seattle USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamilyn M.","family":"Zepp","sequence":"additional","affiliation":[{"name":"Department of Translational and Applied Genomics Center for Health Research, Kaiser Permanente Northwest  Oregon Portland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrina A. B.","family":"Goddard","sequence":"additional","affiliation":[{"name":"Department of Translational and Applied Genomics Center for Health Research, Kaiser Permanente Northwest  Oregon Portland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beth","family":"Devine","sequence":"additional","affiliation":[{"name":"The Comparative Health Outcomes, Policy and Economics (CHOICE) Institute, School of Pharmacy University of Washington  Washington Seattle USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,6,9]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.10987"},{"key":"e_1_2_10_3_1","unstructured":"WeissJM GuptaS BurkeCA et al. NCCN Guidelines Insights: genetic\/familial high\u2010risk assessment: colorectal version 1.2021. 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