Notification



Notification Issue Date:



Medical Policy Bulletin


Title:Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy

Policy #:11.08.19m

This policy is applicable to the Company’s commercial products only. Policies that are applicable to the Company’s Medicare Advantage products are accessible via a separate Medicare Advantage policy database.


The Company makes decisions on coverage based on Policy Bulletins, benefit plan documents, and the member’s medical history and condition. Benefits may vary based on contract, and individual member benefits must be verified. The Company determines medical necessity only if the benefit exists and no contract exclusions are applicable.

When services can be administered in various settings, the Company reserves the right to reimburse only those services that are furnished in the most appropriate and cost-effective setting that is appropriate to the member’s medical needs and condition. This decision is based on the member’s current medical condition and any required monitoring or additional services that may coincide with the delivery of this service.

This Medical Policy Bulletin document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy Bulletin will be reviewed regularly and be updated as scientific and medical literature becomes available. For more information on how Medical Policy Bulletins are developed, go to the About This Site section of this Medical Policy Web site.



Policy

Coverage is subject to the terms, conditions and limitations of the member's contract.

PROPHYLACTIC MASTECTOMY

Prophylactic mastectomy is considered medically necessary and, therefore, covered in individuals who have a high risk or moderately increased risk of developing breast cancer.

For the criteria below, first-degree relatives include parents, children, and siblings. Second-degree relatives include grandparents, aunts, and uncles. Third-degree relatives include great-grandparents and first-degree cousins.

Individuals are considered to have a high risk for breast cancer when they have one or more of the following:
  • Two or more first-degree relatives with breast cancer
  • One first-degree relative and two or more second-degree or third-degree relatives with breast cancer
  • One first-degree relative with breast cancer diagnosed by 45 years of age and one other relative (of any degree) with breast cancer
  • One first-degree relative with breast cancer and one or more relatives (of any degree) with ovarian cancer
  • Two second-degree or third-degree relatives with breast cancer and one or more with ovarian cancer
  • One second-degree or third-degree relative with breast cancer and two or more relatives (of any degree) with ovarian cancer
  • Three or more second-degree or third-degree relatives with breast cancer
  • One first-degree relative with bilateral breast cancer
  • Diagnosis of invasive ductal carcinoma (IDC) or lobular carcinoma in situ (LCIS)
  • High risk (lifetime risk about 20% or greater) of developing breast cancer as identified by models that are largely defined by family history
  • History of exposure/treatment with thoracic radiation, especially at a young age (between 10 and 30 years of age)
  • Presence of breast risk cancer antigen (BRCA1 or BRCA2) gene mutation
  • Ethnicity associated with higher BRCA mutation frequency, such as individuals of Ashkenazi Jewish descent
  • Li-Fraumeni syndrome, Cowden syndrome, Bannayan-Riley-Ruvalcaba syndrome, or a first-degree relative with one of these syndromes
  • Presence of a TP53, CDH1, STK11 or PTEN gene mutation

The following individuals are considered to be at moderately increased risk for breast cancer:
  • Individuals who do not meet the definition of high risk, but nonetheless are considered at moderately increased risk based on family history with or without breast lesions associated with an increased risk, including, but not limited to, atypical hyperplasia or individuals with any type of breast cancer diagnosed in the opposite breast
  • Individuals with such extensive mammographic abnormalities (e.g., cystic/dense breast tissue, calcifications) that adequate biopsy is impossible
  • History of previous or planned mastectomy for an invasive cancer

All other uses for prophylactic mastectomy are considered not medically necessary and, therefore, not covered because the available published peer-reviewed literature does not support their use in the treatment of illness or injury.


PROPHYLACTIC OOPHORECTOMY/SALPINGO-OOPHORECTOMY

For the criteria below, first-degree relatives include parents, children, and siblings. Second-degree relatives include grandparents, aunts, and uncles.

Prophylactic oophorectomy or salpingo-oophorectomy is considered medically necessary and, therefore, covered in individuals with high risk factors for ovarian cancer if they meet ANY of the following criteria:
  • Individuals with breast and ovarian susceptibility gene (BRCA1 or BRCA2) mutations confirmed by genetic testing
  • Individuals with a known familial cancer syndrome associated with increased risk of ovarian cancer (e.g., hereditary nonpolyposis colorectal cancer [HNPCC], Lynch syndrome)
  • Individuals with a personal history of breast cancer and at least one first-degree relative with a history of ovarian cancer
  • Individuals with two or more first-degree relatives with a history of ovarian and/or breast cancer
  • Individuals with one first degree relative and one or more second degree relative with a history of ovarian cancer
  • Individuals who are beyond childbearing age (40 years of age or older) who have been diagnosed with a hereditary ovarian cancer syndrome based on a family pedigree constructed by a genetic counselor or physician competent in determining the presence of an autosomal dominant inheritance pattern in which genetic testing is either not available or uninformative
  • Individuals with a premenopausal history of steroid hormone receptor-positive breast cancer

Prophylactic oophorectomy or salpingo-oophorectomy for indications that do not meet the above criteria are considered experimental/investigational and, therefore, not covered because the safety and/or effectiveness of this service cannot be established by review of the available published peer-reviewed literature.


PROPHYLACTIC HYSTERECTOMY

Prophylactic hysterectomy when performed with bilateral oophorectomy is considered medically necessary and, therefore, covered in individuals if they meet ANY of the following criteria:
  • Individuals have been diagnosed with hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome
  • Individuals who have been found to be carriers of HNPCC-associated mutations
  • Individuals are members of HNPCC families as determined by a pattern of occurrence of HNPCC-related cancers
  • Individuals who meet the criteria for a prophylactic oophorectomy and who, after a risk/benefit discussion with their professional provider, choose to have prophylactic hysterectomy in conjunction with oophorectomy

Prophylactic hysterectomy for indications that do not meet the above criteria are considered experimental/investigational and, therefore, not covered because the safety and/or effectiveness of this service cannot be established by review of the available published peer-reviewed literature.


REQUIRED DOCUMENTATION

The individual's medical record must reflect the medical necessity for the care provided. These medical records may include, but are not limited to: records from the professional provider's office, hospital, nursing home, home health agencies, therapies, and test reports.

The Company may conduct reviews and audits of services to our members, regardless of the participation status of the provider. All documentation is to be available to the Company upon request. Failure to produce the requested information may result in a denial for the service.
Guidelines

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable benefit contract, prophylactic mastectomy, prophylactic oophorectomy/salpingo-oophorectomy, and prophylactic hysterectomy are covered under the medical benefits of the Company’s products when the medical necessity criteria listed in the medical policy are met.

Description

PROPHYLACTIC MASTECTOMY

Prophylactic mastectomy is the removal of breast tissue (unilateral or bilateral) in the absence of malignant disease to prevent breast cancer in high-risk individuals. Current research supports the efficacy of prophylactic mastectomy in individuals who, when compared with the general population, are determined to be at increased risk (high risk or moderate risk) for breast cancer. Increased risk is based upon a formal evaluation of family history using established risk-assessment procedures such as the Gail model and/or the Claus model.

Individuals at an increased risk for developing breast cancer include those with an extensive family history of breast cancer (i.e., a history of early-onset disease), women with ovarian cancer occurring in multiple generations, individuals who have the breast cancer risk antigen BRCA1 or BRCA2 gene mutation, individuals with TP53, CDH1, STK11, and PTEN gene mutations, individuals with prior history of thoracic radiation, and individuals who have breast lesions associated with an increased cancer risk (e.g., atypical hyperplasia, lobular carcinoma in situ [LCIS], invasive ductal carcinoma [IDC]).

While high risk is more objectively defined by family history or the presence of a BRCA1 or BRCA2 gene mutation, moderate risk may be conferred by a wide range of family histories in association with different types of breast pathologies.

Typically, prophylactic mastectomy is bilateral, but it can be unilateral when performed in an individual who has previously undergone or is presently undergoing a mastectomy in the opposite breast for an invasive cancer.

Prophylactic mastectomy is defined as either total (simple) mastectomy or subcutaneous mastectomy. Total mastectomy is the removal of the entire breast and nipple-areolar complex. Subcutaneous mastectomy is the removal of the breast tissue, but the nipple-areolar complex is left intact for a more natural appearance. From a prophylactic standpoint, a total mastectomy is generally preferred over a subcutaneous mastectomy because there is less residual breast tissue remaining, which decreases the likelihood that breast cancer will develop in the future. However, prophylactic mastectomy is only one form of breast cancer risk-reduction strategy. It does not provide 100 percent protection against the development of breast cancer.


PROPHYLACTIC OOPHORECTOMY/SALPINGO-OOPHORECTOMY

Prophylactic oophorectomy is the preventive, surgical removal of the ovaries. Prophylactic salpingo-oophorectomy is the preventive, surgical removal of the fallopian tubes and ovaries. The goal of prophylactic oophorectomy or salpingo-oophorectomy is to prevent the development of ovarian cancer and/or reduce the risk of breast cancer in individuals who are at high risk for these diseases.

Ovarian epithelial carcinoma is one of the most common gynecologic malignancies and the leading cause of death due to gynecologic malignancy. Most individuals are diagnosed after the age of 50, with the greatest risk of ovarian cancer occurring in individuals over the age of 70. The lifetime risk of developing ovarian cancer is 1.7% for the general population. Due to the inadequacies of existing screening techniques, which include pelvic examination, transvaginal ultrasound, and serum CA-125 testing, most cases of ovarian cancer go undiagnosed until the disease is well advanced and survival rates for ovarian cancer are very poor. The etiology of ovarian cancer is uncertain but increased age, nulliparity, and a family history of the disease confer an increased risk, with family history being the strongest risk factor.

There are three major ovarian cancer syndromes: hereditary breast and ovarian cancer (HBOC), which is caused by mutations in the breast cancer susceptibility genes BRCA1 and BRCA2, site-specific ovarian cancer syndrome, and Lynch Syndrome (a combination of breast, ovarian, endometrial, gastrointestinal, and genitourinary cancers), which is associated with hereditary nonpolyposis colorectal cancer (HNPCC). Autosomal dominant inheritance has been shown in some of these mutations, and the lifetime risk for ovarian cancer associated with these syndromes ranges from 5% to over 60%, depending on the population studied. Individuals who have these gene mutations are at risk for other cancers, and the lifetime risk of breast cancer among individuals with a mutation in BRCA1 or BRCA2 approaches 90%. While screening measures for breast cancer generally detect tumors at earlier stages than do ovarian cancer screening measures, no screening test for either breast or ovarian cancer has been shown to decrease cancer risk.


PROPHYLACTIC HYSTERECTOMY

Prophylactic hysterectomy is the preventative, surgical removal of the uterus to prevent disease or cancer. The goal of prophylactic hysterectomy is to prevent the development of cancers involving the uterus in individuals who are at high risk for these diseases.
References


5th International Symposium on Hereditary Breast and Ovarian Cancer,BRCA: Twenty Years of Advances.Current Oncology. 2014;21(2):e358.

American College of Obstetricians and Gynecologists. ACOG Committee Opinion number 620, Salpingectomy for Ovarian Cancer Prevention. February 2016. Available at: http://www.acog.org/-/media/Committee-Opinions/Committee-on-Gynecologic-Practice/co620.pdf?dmc=1. Accessed January 28, 2019.

American College of Obstetricians and Gynecologists; ACOG Committee on Practice Bulletins--Gynecology; ACOG Committee on Genetics; Society of Gynecologic Oncologists. ACOG Practice Bulletin No.182: Hereditary breast and ovarian cancer syndrome. Obstet Gynecol.2017 Sep; 130(3):664-665.

American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 89. Elective and risk-reducing salpingo-oophorectomy. Obstet Gynecol. 2008;111(1):231-41.

Arts-de JM, Harmsen MG, Hoogerbrugge N, et al. Risk-reducing salpingectomy with delayed oophorectomy inBRCA1/2 mutation carriers: Patients' and professionals' perspectives.Gynecol Oncol. 2015;136(2):305-310.

Arver B, Isaksson K, Atterhem H, et al. Bilateral prophylactic mastectomy in Swedish women at high risk of breast cancer: a national survey.Ann Surg. 2011;253(6):1147-1154.

Bacha OM, Gregoire J, Grondin K, et al. Effectiveness of risk-reducing salpingo-oophorectomy in preventing ovarian cancer in a high-risk French Canadian population.Int J Gynecol Cancer. 2012;22(6):974-978.

Bancroft EK, Locke I, Ardern-Jones A, et al. The carrier clinic: an evaluation of a novel clinic dedicated to the follow-up ofBRCA1 andBRCA2 carriers--implications for oncogenetics practice.J Med Genet. 2010;47(7):486-491.

Barlin J, Pike M, Otegbeye E, et al. Does postmenopausal risk-reducing salpingo-oophorectomy reduce the risk of BRCA-associated breast cancer? Gynecologic Oncology. 2013;130(1):e103-e104.

Barlin JN, Arnold A, Mobley S, et al. Breast cancer risk with hormone replacement after risk-reducing salpingo-oophorectomy in BRCA mutation carriers: Does it abrogate the benefit? Gynecologic Oncology. 2014;133:79.

Bermejo-Prez MJ, Mrquez-Caldern S, Llanos-Mndez A. Effectiveness of preventive interventions in BRCA1/2 gene mutation carriers: a systematic review. Int J Cancer. 2007;121(2):225-31.

Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Bilateral prophylactic mastectomy in women with an increased risk of breast cancer. TEC Assessments. 1999; Volume 14:Tab 14.

Bober S, Garber J, Recklitis CJ, et al. A pilot intervention addressing sexual dysfunction after risk-reducing oophorectomy. Journal of Clinical Oncology. 2013;31(15).

Bober SL, Recklitis CJ, Bakan J, et al. Addressing sexual dysfunction after risk-reducing salpingo-oophorectomy: effects of a brief, psychosexual intervention. J Sex Med. 2015;12(1):189-197.

Brotto LA, Branco N, Dunkley C, et al. Risk-reducing bilateral salpingo-oophorectomy and sexual health: a qualitative study. J Obstet Gynaecol Can. 2012;34(2):172-178.

Burger A, Thurtle D, Owen S, et al. Sentinel lymph node biopsy for risk-reducing mastectomy. Breast J. 2013;19(5):529-532.

Burke W, Petersen G, Lynch P, et al. Recommendations for follow-up care of individuals with an inherited predisposition to cancer. I. Hereditary nonpolyposis colon cancer. Cancer Genetics Studies Consortium. JAMA. 1997;277(11):915-9.

Campfield BD, Moyer A, Matloff ET. What I wish I'd known before surgery: BRCA carriers' perspectives after bilateral salipingo-oophorectomy. Fam Cancer. 2011;10(1):79-85.

Carroll PA, Nolan C, Clarke R, et al. Surgical management of an Irish cohort of BRCA-mutation carriers. Breast. 2011;20(5):419-423.

Casey MJ, Synder C, Bewtra C, et al. Intra-abdominal carcinomatosis after prophylactic oophorectomy in women of hereditary breast ovarian cancer syndrome kindreds associated with BRCA1 and BRCA2 mutations. Gynecol Oncol. 2005;97(2):457-67.

Cass I, Walsh C, Lester J, et al. Patterns of care for risk-reducing salpingo-oophorectomy (RRSO) for BRCA mutation carriers and subsequent surveillance. Gynecologic Oncology. 2013;130(1):e104-e105.

Cass I, Walts AE, Barbuto D, et al. A cautious view of putative precursors of serous carcinomas in the fallopian tubes of BRCA mutation carriers. Gynecol Oncol. 2014;134(3):492-497.

Chai X, Friebel TM, Singer CF, et al. Use of risk-reducing surgeries in a prospective cohort of 1,499 BRCA1 and BRCA2 mutation carriers. Breast Cancer Res Treat. 2014;148(2):397-406.

Chapman J, Panighetti A, Hwang S, et al. Comparing coordinated versus sequential salpingo-oophorectomy for BRCA1 and BRCA2 mutation carriers with breast cancer. Gynecologic Oncology. 2013;130(1):e105.

Chapman JS, Powell CB, McLennan J, et al. Surveillance of survivors: follow-up after risk-reducing salpingo-oophorectomy in BRCA 1/2 mutation carriers. Gynecol Oncol. 2011;122(2):339-343.

Chen Y, Bancroft E, Ashley S, et al. Baseline and post prophylactic tubal-ovarian surgery CA125 levels in BRCA1 and BRCA2 mutation carriers. Fam Cancer. 2014;13(2):197-203.

Cherry C, Ropka M, Lyle J, et al. Understanding the Needs of Women Considering Risk-Reducing Salpingo-oophorectomy. Cancer Nurs. 2013;36(3):E33-E38.

Cohen JV, Chiel L, Boghossian L, et al. Non-cancer endpoints in BRCA1/2 carriers after risk-reducing salpingo-oophorectomy. Fam Cancer. 2012;11(1):69-75.

Collins IM, Milne RL, Weideman PC, et al. Preventing breast and ovarian cancers in high-risk BRCA1 and BRCA2 mutation carriers. Med J Aust. 2013;199(10):680-683.

Cortesi L, Razzaboni E, Toss A, et al. A rapid genetic counselling and testing in newly diagnosed breast cancer is associated with high rate of risk-reducing mastectomy in BRCA1/2-positive Italian women. Ann Oncol. 2014;25(1):57-63.

Culver J, Brinkerhoff C, Clague J, et al. Variants of uncertain significance in BRCA testing: evaluation of surgical decisions, risk perception, and cancer distress. Clin Genet. 2013;84(5):464-72.

Davies KR, Cantor SB, Brewster AM. Better contralateral breast cancer risk estimation and alternative options to contralateral prophylactic mastectomy. Int J Womens Health. 2015;7181-187.

Del Corral GA, Wes AM, Fischer JP, et al. Outcomes and Cost Analysis in High-Risk Patients Undergoing Simultaneous Free Flap Breast Reconstruction and Gynecologic Procedures. Ann Plast Surg. 2015;75(5):534-8.

DeLeo MJ, Domchek SM, Kontos D, et al. Breast MRI Fibroglandular Volume and Parenchymal Enhancement in BRCA1 and BRCA2 Mutation Carriers Before and Immediately After Risk-Reducing Salpingo-Oophorectomy. AJR Am J Roentgenol. 2015;204(3):669-673.

Den HM, van Asperen CJ, Harris H, et al. International variation in physicians' attitudes towards prophylactic mastectomy - comparison between France, Germany, the Netherlands and the United Kingdom. Eur J Cancer. 2013;49(13):2798-2805.

Dhar SU, Cooper HP, Wang T, et al. Significant differences among physician specialties in management recommendations of BRCA1 mutation carriers. Breast Cancer Res Treat. 2011;129(1):221-227.

Domchek SM, Friebel TM, Garber JE, et al. Occult ovarian cancers identified at risk-reducing salpingo-oophorectomy in a prospective cohort of BRCA1/2 mutation carriers. Breast Cancer Res Treat. 2010;124(1):195-203.

Domchek SM, Friebel TM, Neuhausen SL, et al. Mortality after bilateral salpingo-oophorectomy in BRCA1 and BRCA2 mutation carriers: a prospective cohort study. Lancet Oncol. 2006;7(3):223-9.

Domchek SM, Friebel TM, Singer CF, et al. Association of risk-reducing surgery in BRCA1 or BRCA2 mutation carriers with cancer risk and mortality. JAMA. 2010;304(9):967-975.

Domchek SM, Rebbeck TR. Prophylactic oophorectomy in women at increased cancer risk. Curr Opin Obstet Gynecol. 2007;19(1):27-30.

Eck DL, Perdikis G, Rawal B, et al. Incremental risk associated with contralateral prophylactic mastectomy and the effect on adjuvant therapy. Ann Surg Oncol. 2014;21(10):3297-3303.

Eisen A, Rebbeck TR, Wood WC, et al. Prophylactic surgery in women with a hereditary predisposition to breast and ovarian cancer. J Clin Oncol. 2000;18(9):1980-95.

Eleje GU, Eke AC, Ezebialu IU, et al. Risk Reducing bilateral salpingo-oopherectomy in women with BRCA1 or BRCA2 mutations. Cochrane Database Syst Rev. 2018;8:CD012464 Available at: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012464.pub2/full. Accessed January 28, 2019.

Elsayegh N, Kuerer HM, Lin H, et al. Predictors that influence contralateral prophylactic mastectomy election among women with ductal carcinoma in situ who were evaluated for BRCA genetic testing. Ann Surg Oncol. 2014;21(11):3466-3472.

Evans DG, Ingham SL, Baildam A, et al. Contralateral mastectomy improves survival in women with BRCA1/2-associated breast cancer. Breast Cancer Res Treat. 2013;140(1):135-142.

Fakkert IE, Abma EM, Westrik IG, et al. Bone mineral density and fractures after risk-reducing salpingo-oophorectomy in women at increased risk for breast and ovarian cancer. Eur J Cancer. 2015;51(3):400-408.

Fakkert IE, Abma EM, Westrik IG, et al. Bone mineral density and fractures after risk-reducing salpingo-oophorectomy: A cross-sectional study. International Journal of Gynecological Cancer. 2014;24(9):321-322.

Fakkert IE, Jansen L, Meijer K, et al. Breast cancer screening in BRCA1 and BRCA2 mutation carriers after risk reducing salpingo-oophorectomy. Breast Cancer Res Treat. 2011;129(1):157-164.

Fakkert IE, Mourits MJ, Jansen L, et al. Breast Cancer Incidence After Risk-Reducing Salpingo-Oophorectomy in BRCA1 and BRCA2 Mutation Carriers. Cancer Prev Res (Phila). 2012;5(11):1291-1297.

Fayanju OM, Stoll CR, Fowler S, et al. Contralateral prophylactic mastectomy after unilateral breast cancer: a systematic review and meta-analysis. Ann Surg. 2014;260(6):1000-1010.

Finch A, Beiner M, Lubinski J, et al. Salpingo-oophorectomy and the risk of ovarian, fallopian tube, and peritoneal cancers in women with a BRCA1 or BRCA2 mutation. JAMA. 2006;296(2):185-192.

Finch A, Metcalfe KA, Chiang J, et al. The impact of prophylactic salpingo-oophorectomy on quality of life and psychological distress in women with a BRCA mutation. Psychooncology. 2013;22(1):212-219.

Finch A, Metcalfe KA, Chiang JK, et al. The impact of prophylactic salpingo-oophorectomy on menopausal symptoms and sexual function in women who carry a BRCA mutation. Gynecol Oncol. 2011;121(1):163-168.

Finch A, Narod SA. Quality of life and health status after prophylactic salpingo-oophorectomy in women who carry a BRCA mutation: A review. Maturitas. 2011;70(3):261-265.

Finch AP, Lubinski J, Moller P, et al. Impact of oophorectomy on cancer incidence and mortality in women with a BRCA1 or BRCA2 mutation. J Clin Oncol. 2014;32(15):1547-1553.

Finkelman BS, Rubinstein WS, Friedman S, et al. Breast and ovarian cancer risk and risk reduction in Jewish BRCA1/2 mutation carriers. J Clin Oncol. 2012;30(12):1321-1328.

Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: Report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst. 1998;90(18):1371-88.

Gadducci A, Biglia N, Cosio S, et al. Gynaecologic challenging issues in the management of BRCA mutation carriers: oral contraceptives, prophylactic salpingo-oophorectomy and hormone replacement therapy. Gynecol Endocrinol. 2010;26(8):568-577.

Gail MH, Benichou J. Validation studies on a model for breast cancer risk. J Natl Cancer Inst. 1994;86(8):573-75.

Gail MH, Brinton LA, Byar DP, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst. 1989;81(24):1879-86.

Gangi A, Cass I, Paik D, et al. Breast cancer following ovarian cancer in BRCA mutation carriers. JAMA Surg. 2014;149(12):1306-1313.

Garcia C, Lyon L, Littell RD, et al. Comparison of risk management strategies between women testing positive for a BRCA variant of unknown significance and women with known BRCA deleterious mutations. Genet Med. 2014;16(12):896-902.

Garcia C, Lyon L, Littell RD, et al. Risk Management Options Elected by Women after Testing Positive for a BRCA1 or BRCA2 Variant of Unknown Significance Mutation. Current Oncology. 2014;21(2):e365.

Garcia C, Wendt J, Lyon L, et al. Risk management options elected by women after testing positive for a BRCA mutation. Gynecol Oncol. 2014;132(2):428-433.

Geiger AM, Yu O, Herrinton LJ, et al. A population-based study of bilateral prophylactic mastectomy efficacy in women at elevated risk for breast cancer in community practices. Arch Intern Med. 2005;165(5):516-20.

Giuliano AE, Boolbol S, Degnim A, et al. Society of Surgical Oncology: position statement on prophylactic mastectomy. Approved by the Society of Surgical Oncology Executive Council, March 2007. Ann Surg Oncol. 2007;14(9):2425-2427.

Gopie JP, Mureau MA, Seynaeve C, et al. Body image issues after bilateral prophylactic mastectomy with breast reconstruction in healthy women at risk for hereditary breast cancer. Fam Cancer. 2013;12(3):479-87.

Grann VR, Jacobson JS, Thomason D, et al. Effect of prevention strategies on survival and quality-adjusted survival of woman with BRCA 1/2 mutations: an updated decision analysis. J Clin Oncol. 2002;20(10):2520-29.

Grann VR, Jacobson JS, Whang W, et al. Prevention with tamoxifen or other hormones versus prophylactic surgery in BRCA1/2-positive women: a decision analysis. Cancer J Sci Am. 2000;6(1):13-20.

Grann VR, Patel PR, Jacobson JS, et al. Comparative effectiveness of screening and prevention strategies among BRCA1/2-affected mutation carriers. Breast Cancer Res Treat. 2011;125(3):837-847.

Greene MH, Mai PL, Schwartz PE. Does bilateral salpingectomy with ovarian retention warrant consideration as a temporary bridge to risk-reducing bilateral oophorectomy in BRCA1/2 mutation carriers? Am J Obstet Gynecol. 2011;204(1):19-6.

Guillem JG, Wood WC, Moley JF, et al. ASCO/SSO review of current role of risk-reducing surgery in common hereditary cancer syndromes. J Clin Oncol. 2006;24(28):4642-60.

Hagen AI, Maehle L, Veda N, et al. Risk reducing mastectomy, breast reconstruction and patient satisfaction in Norwegian BRCA1/2 mutation carriers. Breast. 2014;23(1):38-43.

Haroun I, Graham T, Poll A, et al. Reasons for risk-reducing mastectomy versus MRI-screening in a cohort of women at high hereditary risk of breast cancer. Breast. 2011;20(3):254-258.

Hartmann LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med. 1999;340(2):77-84.

Heemskerk-Gerritsen BA, Menke-Pluijmers MB, Jager A, et al. Substantial breast cancer risk reduction and potential survival benefit after bilateral mastectomy when compared with surveillance in healthy BRCA1 and BRCA2 mutation carriers: a prospective analysis. Ann Oncol. 2013;24(8):2029-35..

Heemskerk-Gerritsen BA, Rookus MA, Aalfs CM, et al. Improved overall survival after contralateral risk-reducing mastectomy in BRCA1/2 mutation carriers with a history of unilateral breast cancer: a prospective analysis. Int J Cancer. 2015;136(3):668-677.

Heemskerk-Gerritsen BA, Seynaeve C, van Asperen CJ, et al. Breast Cancer Risk After Salpingo-Oophorectomy in Healthy BRCA1/2 Mutation Carriers: Revisiting the Evidence for Risk Reduction. J Natl Cancer Inst. 2015;107(5).

Herrinton LJ, Barlow WE, Yu O, et al. Efficacy of prophylactic mastectomy in women with unilateral breast cancer: A cancer research network project. J Clin Oncol. 2005;23(19):4275-86.

Hirasawa A, Masuda K, Akahane T, et al. Experience of Risk-reducing Salpingo-oophorectomy for a BRCA1 Mutation Carrier and Establishment of a System Performing a Preventive Surgery for Hereditary Breast and Ovarian Cancer Syndrome in Japan: Our Challenges for the Future. Jpn J Clin Oncol. 2013;43(5):515-519.

Holman LL, Friedman S, Daniels MS, et al. Acceptability of prophylactic salpingectomy with delayed oophorectomy as risk-reducing surgery among BRCA mutation carriers. Gynecol Oncol. 2014;133(2):283-286.

Hooker GW, King L, Vanhusen L, et al. Long-term satisfaction and quality of life following risk reducing surgery in BRCA1/2 mutation carriers. Hered Cancer Clin Pract. 2014;12(1):9.

Hoover DJ, Paragi PR, Santoro E, et al. Prophylactic mastectomy in high risk patients: a practice-based review of the indications. Do we follow guidelines? Breast Dis. 2010;31(1):19-27.

Horsman D, Wilson BJ, Avard D, et al. Clinical management recommendations for surveillance and risk-reduction strategies for hereditary breast and ovarian cancer among individuals carrying a deleterious BRCA1 or BRCA2 mutation. J Obstet Gynaecol Can. 2007;29(1):45-60.

Hoskins LM, Greene MH. Anticipatory loss and early mastectomy for young female BRCA1/2 mutation carriers. Qual Health Res. 2012;22(12):1633-1646.

Howard AF, Balneaves LG, Bottorff JL, et al. Preserving the self: the process of decision making about hereditary breast cancer and ovarian cancer risk reduction. Qual Health Res. 2011;21(4):502-519.

Howard AF, Bottorff JL, Balneaves LG, et al. Women's constructions of the 'right time' to consider decisions about risk-reducing mastectomy and risk-reducing oophorectomy. BMC Womens Health. 2010;10:24.

Hughes KS, Papa MZ, Whitney T, et al. Prophylactic mastectomy and inherited predisposition to breast carcinoma. Cancer. 1999;86(11 Suppl):2502-16.

Igelhart JD, Kaelin CM. Diseases of the breast. In: Townsend CM, Beauchamp DR, Evers MB, et al, eds. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 16th ed. Philadelphia, PA: WB Saunders Co; 2001: 573-580.

Ingham SL, Sperrin M, Baildam A, et al. Risk-reducing surgery increases survival in BRCA1/2 mutation carriers unaffected at time of family referral. Breast Cancer Res Treat. 2013;142(3):611-618.

Jatoi I, Parsons HM. Contralateral prophylactic mastectomy and its association with reduced mortality: evidence for selection bias. Breast Cancer Res Treat. 2014;148(2):389-396.

Julian-Reynier C, Bouhnik AD, Mouret-Fourme E, et al. Time to prophylactic surgery in BRCA1/2 carriers depends on psychological and other characteristics. Genet Med. 2010;12(12):801-807.

Kaas R, Verhoef S, Wesseling J, et al. Prophylactic mastectomy in BRCA1 and BRCA2 mutation carriers: very low risk for subsequent breast cancer. Ann Surg. 2010;251(3):488-492.

Kauff ND, Satagopan JM, Rosen ME, et al. Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med. 2002;346(21):1609-15.

Kenkhuis MJ, de Bock GH, Elferink PO, et al. Short-term surgical outcome and safety of risk reducing salpingo-oophorectomy in BRCA1/2 mutation carriers. Maturitas. 2010;66(3):310-314.

Khadim MF, Eastwood P, Price J, et al. Multidisciplinary one-stage risk-reducing gynaecological and breast surgery with immediate reconstruction in BRCA-gene carrier women. Eur J Surg Oncol. 2013;39(12):1346-1350.

Kiely BE, Jenkins MA, McKinley JM, et al. Contralateral risk-reducing mastectomy in BRCA1 and BRCA2 mutation carriers and other high-risk women in the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer (kConFab). Breast Cancer Res Treat. 2010;120(3):715-723.

Kim D, Kang E, Hwang E, et al. Factors affecting the decision to undergo risk-reducing salpingo-oophorectomy among women with BRCA gene mutation. Fam Cancer. 2013;12(4):621-8.

Koskenvuo L, Svarvar C, Suominen S, et al. The frequency and outcome of breast cancer risk-reducing surgery in Finnish BRCA1 and BRCA2 mutation carriers. Scand J Surg. 2014;103(1):34-40.

Kruper L, Kauffmann RM, Smith DD, et al. Survival analysis of contralateral prophylactic mastectomy: a question of selection bias. Ann Surg Oncol. 2014;21(11):3448-3456.

Kurian AW, Munoz DF, Rust P, et al. Online tool to guide decisions for BRCA1/2 mutation carriers. J Clin Oncol. 2012;30(5):497-506.

Kurian AW, Sigal BM, Plevritis SK. Survival analysis of cancer risk reduction strategies for BRCA1/2 mutation carriers. J Clin Oncol. 2010;28(2):222-231.

Kuschel B, Lux MP, Goecke TO, et al. Prevention and therapy for BRCA1/2 mutation carriers and women at high risk for breast and ovarian cancer. Eur J Cancer Prev. 2000;9(3):139-50.

Kwon JS, Tinker A, Pansegrau G, et al. Prophylactic salpingectomy and delayed oophorectomy as an alternative for BRCA mutation carriers. Obstet Gynecol. 2013;121(1):14-24.

Kwong A, Chu AT. What made her give up her breasts: a qualitative study on decisional considerations for contralateral prophylactic mastectomy among breast cancer survivors undergoing BRCA1/2 genetic testing. Asian Pac J Cancer Prev. 2012;13(5):2241-2247.

Kwong A, Wong CH, Shea C, et al. Choice of management of southern Chinese BRCA mutation carriers. World J Surg. 2010;34(7):1416-1426.

Laitman Y, Vaisman Y, Feldman D, et al. Rates of risk-reducing surgery in Israeli BRCA1 and BRCA2 mutation carriers. Clin Genet. 2014;85(1):68-71.

Lancaster JM, Powell CB, Kauf ND, et al. Society of Gynecologic Oncologists Education Committee Statement on Risk Assessment for Inherited Gynecologic Cancer Predispositions. Gyn Oncol. 2007;107(2):159-62.

Landon G, Stewart J, Deavers M, et al. Peritoneal washing cytology in patients with BRCA1 or BRCA2 mutations undergoing risk-reducing salpingo-oophorectomies: a 10-year experience and reappraisal of its clinical utility. Gynecol Oncol. 2012;125(3):683-686.

Landsbergen KM, Prins JB, Kamm YJ, et al. Female BRCA mutation carriers with a preference for prophylactic mastectomy are more likely to participate an educational-support group and to proceed with the preferred intervention within 2 years. Fam Cancer. 2010;9(2):213-220.

Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A joint guideline from the American Cancer Society, the US multi-society task force on colorectal cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58(3).

Lindor NM, Petersen GM, Hadley DW, et al. Recommendations for the care of individuals with an inherited predisposition to Lynch syndrome: a systematic review. JAMA. 2006;296(12):1507-17.

Lostumbo L, Carbine NE, Wallace J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev. 2010;11:CD002748.

Manchanda R, Abdelraheim A, Johnson M, et al. Outcome of risk-reducing salpingo-oophorectomy in BRCA carriers and women of unknown mutation status. BJOG. 2011;118(7):814-824.

Manchanda R, Burnell M, Abdelraheim A, et al. Factors influencing uptake and timing of risk reducing salpingo-oophorectomy in women at risk of familial ovarian cancer: a competing risk time to event analysis. BJOG. 2012;119(5):527-536.

Mannis GN, Fehniger JE, Creasman JS, et al. Risk-reducing salpingo-oophorectomy and ovarian cancer screening in 1077 women after BRCA testing. JAMA Intern Med. 2013;173(2):96-103.

Marchetti C, De FF, Palaia I, et al. Risk-reducing salpingo-oophorectomy: a meta-analysis on impact on ovarian cancer risk and all cause mortality in BRCA 1 and BRCA 2 mutation carriers. BMC Womens Health. 2014;14(1):150.

Marchetti C, Iadarola R, Palaia I, et al. Hormone therapy in oophorectomized BRCA1/2 mutation carriers. Menopause. 2014;21(7):763-768.

Matloff ET, Bonadies DC, Moyer A, et al. Changes in specialists' perspectives on cancer genetic testing, prophylactic surgery and insurance discrimination: then and now. J Genet Couns. 2014;23(2):164-171.

McQuirter M, Castiglia LL, Loiselle CG, et al. Decision-making process of women carrying a BRCA1 or BRCA2 mutation who have chosen prophylactic mastectomy. Oncol Nurs Forum. 2010;37(3):313-320.

Meeuwissen PA, Seynaeve C, Brekelmans CT, et al. Outcome of surveillance and prophylactic salpingo-oophorectomy in asymptomatic women at high risk for ovarian cancer. Gynecol Oncol. 2005;97(2):476-82.

Meijers-Heijboer H, Brekelmans CT, Menke-Pluymers M, et al. Use of genetic testing and prophylactic mastectomy and oophorectomy in women with breast or ovarian cancer from families with a BRCA1 or BRCA2 mutation. J Clin Oncol. 2003;21(9):1675-81.

Meindl A, Ditsch N, Kast K, et al. Hereditary breast and ovarian cancer: new genes, new treatments, new concepts. Dtsch Arztebl Int. 2011;108(19):323-330.

Meiser B, Price MA, Butow PN, et al. Psychosocial factors and uptake of risk-reducing salpingo-oophorectomy in women at high risk for ovarian cancer. Fam Cancer. 2013;12(1):101-109.

Metcalfe KA, Kim-Sing C, Ghadirian P, et al. Health care provider recommendations for reducing cancer risks among women with a BRCA1 or BRCA2 mutation. Clin Genet. 2014;85(1):21-30.

Metcalfe KA, Mian N, Enmore M, et al. Long-term follow-up of Jewish women with a BRCA1 and BRCA2 mutation who underwent population genetic screening. Breast Cancer Res Treat. 2012;133(2):735-740.

Miller ME, Czechura T, Martz B, et al. Operative risks associated with contralateral prophylactic mastectomy: a single institution experience. Ann Surg Oncol. 2013;20(13):4113-4120.

Miller SM, Roussi P, Daly MB, et al. New strategies in ovarian cancer: uptake and experience of women at high risk of ovarian cancer who are considering risk-reducing salpingo-oophorectomy. Clin Cancer Res. 2010;16(21):5094-5106.

Mingels MJ, Roelofsen T, van der Laak JA, et al. Tubal epithelial lesions in salpingo-oophorectomy specimens of BRCA-mutation carriers and controls. Gynecol Oncol. 2012;127(1):88-93.

Molina-Montes E, Perez-Nevot B, Pollan M, et al. Cumulative risk of second primary contralateral breast cancer in BRCA1/BRCA2 mutation carriers with a first breast cancer: A systematic review and meta-analysis. Breast. 2014;23(6):721-742.

Murphy RX, Jr., Adkinson JM, Namey T, et al. Surgical and financial implications of genetic counseling and requests for concurrent prophylactic mastectomy. Ann Plast Surg. 2010;64(5):684-687.

Murray ML, Cerrato F, Bennett RL, et al. Follow-up of carriers of BRCA1 and BRCA2 variants of unknown significance: variant reclassification and surgical decisions. Genet Med. 2011;13(12):998-1005.

Muto MG. Risk-reducing bilateral salpingo-oophorectomy in women at high risk of epithelial ovarian and fallopian tubal cancer. In: UpToDate, Goff B (Ed), UpToDate, Waltham, MA. Last updated September 17, 2015. Available at: http://www.uptodate.com/contents/risk-reducing-bilateral-salpingo-oophorectomy-in-women-at-high-risk-of-epithelial-ovarian-and-fallopian-tubal-cancer?source=search_result&search=prophylactic+oophorectomy&selectedTitle=1%7E26. Accessed January 28, 2019.

Nair N, Schwartz M, Guzzardi L, et al. Hysterectomy at the time of risk-reducing surgery in BRCA patients. Gynecol Oncol Rep. 2018;26:71-74.

National Cancer Institute (NCI). Cancer Genetics Overview (PDQ) - Health Professional Version. Updated October 10, 2018. Available at: http://www.cancer.gov/about-cancer/causes-prevention/genetics/overview-pdq#link/_123. Accessed January 28, 2019.

National Cancer Institute (NCI). Fact Sheet: Surgery to Reduce the Risk of Breast Cancer. 2012, reviewed in 2013; Available at: http://www.cancer.gov/cancertopics/factsheet/Therapy/risk-reducing-surgery. Accessed January 28, 2019.

National Cancer Institute (NCI). Genetics of Breast and Gynecologic Cancers (PDQ) - Health Professional Version. Updated September 14, 2018. Available at: http://www.cancer.gov/types/breast/hp/breast-ovarian-genetics-pdq. Accessed January 28, 2019.

National Cancer Institute (NCI). Genetics of Colorectal Cancer (PDQ) - Health Professional Version. Updated March 1, 2018. Available at: http://www.cancer.gov/types/colorectal/hp/colorectal-genetics-pdq. Accessed January 28, 2019.

National Cancer Institute (NCI). Ovarian, Fallopian Tube, and Primary Peritoneal Cancer Prevention (PDQ) - Health Professional Version. Updated January 4, 2019. Available at: http://www.cancer.gov/types/ovarian/hp/ovarian-prevention-pdq. Accessed January 28, 2019.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology - Breast Cancer.V.3.2018. [NCCN Web site].10/25/2018. Available at: http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf [via subscription only]. Accessed January 28,2019.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology - Breast Cancer Risk Reduction.V.1.2019. [NCCN Web site]. 12/11/2018. Available at: http://www.nccn.org/professionals/physician_gls/PDF/breast_risk.pdf [via subscription only]. Accessed January 28, 2019.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology - Breast Cancer Screening and Diagnosis.V.3.2018. [NCCN Web site] 10/04/2018. Available at: http://www.nccn.org/professionals/physician_gls/PDF/breast-screening.pdf [via subscription only]. Accessed January 28, 2019.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology - Genetic/Familial High-Risk Assessment: Breast and Ovarian.V.3.2019. [NCCN Web site]. 01/18/2019. Available at: http://www.nccn.org/professionals/physician_gls/PDF/genetics_screening.pdf [via subscription only]. Accessed January 28, 2019.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology - Genetic/Familial High-Risk Assessment: Colorectal. V.1. 2018. [NCCN Web site]. 07/12/2018. Available at: https://www.nccn.org/professionals/physician_gls/pdf/genetics_colon.pdf [via subscription only]. Accessed January 28, 2019.

National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology - Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer.V.2.2018. [NCCN Web site].03/09/2018. Available at URL address: https://www.nccn.org/professionals/physician_gls/pdf/ovarian.pdf [via subscription only]. Accessed January 28, 2019.

Nelson HD, Fu R, Goddard K, et al. Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: Systematic Review to Update the U.S. Preventive Services Task Force Recommendation [Internet]. U.S. Preventive Services Task Force Evidence Syntheses, formerly Systematic Evidence Reviews. 2013.

Nelson HD, Pappas M, Zakher B, et al. Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: a systematic review to update the U.S. Preventive Services Task Force recommendation. Ann Intern Med. 2014;160(4):255-266.

Newman LA, Kuerer HM, Hung KK, et al. Prophylactic mastectomy. J Am Coll Surg. 2000;191(3):322-30.

Nichols HB, Berrington de Gonzalez A, Lacey JV, Jr., et al. Declining incidence of contralateral breast cancer in the United States from 1975 to 2006. J Clin Oncol. 2011;29(12):1564-1569.

Nisman B, Kadouri L, Allweis T, et al. Increased proliferative background in healthy women with BRCA1/2 haploinsufficiency is associated with high risk for breast cancer. Cancer Epidemiol Biomarkers Prev. 2013;22(11):2110-2115.

Obermair A, Youlden DR, Baade PD, et al. The impact of risk-reducing hysterectomy and bilateral salpingo-oophorectomy on survival in patients with a history of breast cancer--a population-based data linkage study. Int J Cancer. 2014;134(9):2211-2222.

O'Neill SC, Valdimarsdottir HB, Demarco TA, et al. BRCA1/2 test results impact risk management attitudes, intentions, and uptake. Breast Cancer Res Treat. 2010;124(3):755-764.

Oppong BA, King TA. Recommendations for women with lobular carcinoma in situ (LCIS). Oncology (Williston Park). 2011;25(11):1051-1056, 1058.

Peled AW, Irwin CS, Hwang ES, et al. Total skin-sparing mastectomy in BRCA mutation carriers. Ann Surg Oncol. 2014;21(1):37-41.

Perabo M, Fink V, Gunthner-Biller M, et al. Prophylactic mastectomy with immediate reconstruction combined with simultaneous laparoscopic salpingo-oophorectomy via a transmammary route: a novel surgical approach to female BRCA-mutation carriers. Arch Gynecol Obstet. 2014;289(6):1325-1330.

Pesce C, Liederbach E, Wang C, et al. Contralateral prophylactic mastectomy provides no survival benefit in young women with estrogen receptor-negative breast cancer. Ann Surg Oncol. 2014;21(10):3231-3239.

Pezaro C, James P, McKinley J, et al. The consequences of risk reducing salpingo-oophorectomy: the case for a coordinated approach to long-term follow up post surgical menopause. Fam Cancer. 2012;11(3):403-410.

Pichert G, Jacobs C, Jacobs I, et al. Novel one-stop multidisciplinary follow-up clinic significantly improves cancer risk management in BRCA1/2 carriers. Fam Cancer. 2010;9(3):313-319.

Portnoy DB, Loud JT, Han PK, et al. Effects of False-Positive Cancer Screenings and Cancer Worry on Risk-Reducing Surgery Among BRCA1/2 Carriers. Health Psychol. 2015;34(7):709-17.

Powell CB, Chen LM, McLennan J, et al. Risk-reducing salpingo-oophorectomy (RRSO) in BRCA mutation carriers: experience with a consecutive series of 111 patients using a standardized surgical-pathological protocol. Int J Gynecol Cancer. 2011;21(5):846-851.

Powell CB, Swisher EM, Cass I, et al. Long term follow up of BRCA1 and BRCA2 mutation carriers with unsuspected neoplasia identified at risk reducing salpingo-oophorectomy. Gynecol Oncol. 2013;129(2):364-371.

Primas H, Kroiss R, Kalteis K, et al. Impact of lifestyle factors on preneoplastic changes in prophylactic oophorectomies of BRCA mutation carriers. Eur J Cancer Prev. 2012;21(2):199-204.

Ramon YC, Torres A, Alonso C, et al. Risk factors associated with the occurrence of breast cancer after bilateral salpingo-oophorectomy in high-risk women. Cancer Epidemiol. 2011;35(1):78-82.

Rebbeck TR, Lynch HT, Neuhausen SL, et al. Prevention and Observation of Surgical End Points Study Group. Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations. N Engl J Med. 2002;346(21):1616-22.

Reitsma W, de Bock GH, Oosterwijk JC, et al. Support of the 'fallopian tube hypothesis' in a prospective series of risk-reducing salpingo-oophorectomy specimens. Eur J Cancer. 2013;49(1):132-141.

Reynolds C, Davidson JA, Lindor NM, et al. Prophylactic and therapeutic mastectomy in BRCA mutation carriers: can the nipple be preserved? Ann Surg Oncol. 2011;18(11):3102-3109.

Rhiem K, Foth D, Wappenschmidt B, et al. Risk-reducing salpingo-oophorectomy in BRCA1 and BRCA2 mutation carriers. Arch Gynecol Obstet. 2011;283(3):623-627.

Rocca WA, Grossardt BR, de Andrade M, et al. Survival patterns after oophorectomy in premenopausal women: a population-based cohort study. Lancet Oncol. 2006;7(10):821-8.

Rosenberg SM, Tracy MS, Meyer ME, et al. Perceptions, knowledge, and satisfaction with contralateral prophylactic mastectomy among young women with breast cancer: a cross-sectional survey. Ann Intern Med. 2013;159(6):373-381.

Roukos DH, Agnanti NJ, Paraskevaidis E, et al. Approaching the dilemma between prophylactic bilateral mastectomy or oophorectomy for breast and ovarian cancer prevention in carriers of BRCA1 or BRCA2 mutations. Ann Surg Oncol. 2002;9(10):941-3.

Rueth NM, McMahon M, Arrington AK, et al. Preoperative risk assessment among women undergoing bilateral prophylactic mastectomy for cancer risk reduction. Ann Surg Oncol. 2011;18(9):2515-2520.

Salhab M, Bismohun S, Mokbel K. Risk-reducing strategies for women carrying BRCA1/2 mutations with a focus on prophylactic surgery. BMC Womens Health. 2010;1028.

Sakorafas GH, Tsiotou AG. Prophylactic mastectomy; evolving perspectives. Eur J Cancer. 2000;36(5):567-78.

Saslow D, Boetes C, Burke W, et al. American Cancer Society guidelines for breast screening with MRI as an adjunct to mammography. CA Cancer J Clin. 2007;57(2):75-89.

Schmeler KM, Lynch HT, et al. Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch Syndrome. N Engl JMed. 2006;354(3):261-269.

Schrag D(1), Kuntz KM, Garber JE, et al. Decision analysis – Effects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA1 or BRCA2 mutations. N Engl J Med. 1997;336(20):1465-71.

Schwartz MD, Isaacs C, Graves KD, et al. Long-term outcomes of BRCA1/BRCA2 testing: risk reduction and surveillance. Cancer. 2012;118(2):510-517.

Seidman JD. Serous Tubal Intraepithelial Carcinoma Localizes to the Tubal-peritoneal Junction: A Pivotal Clue to the Site of Origin of Extrauterine High-grade Serous Carcinoma (Ovarian Cancer). Int J Gynecol Pathol. 2015;34(2):112-120.

Sherman ME, Piedmonte M, Mai PL, et al. Pathologic findings at risk-reducing salpingo-oophorectomy: primary results from Gynecologic Oncology Group Trial GOG-0199. J Clin Oncol. 2014;32(29):3275-3283.

Sidon L, Ingham S, Clancy T, et al. Uptake of risk-reducing salpingo-oophorectomy in women carrying a BRCA1 or BRCA2 mutation: evidence for lower uptake in women affected by breast cancer and older women. Br J Cancer. 2012;106(4):775-779.

Singer CF, Muhr D, Rappaport C, et al. Clinical implications of genetic testing for BRCA1 and BRCA2 mutations in Austria. Clin Genet. 2014;85(1):72-75.

Silva AK, Lapin B, Yao KA, et al. The effect of contralateral prophylactic mastectomy on perioperative complications in women undergoing immediate breast reconstruction: a NSQIP analysis. Ann Surg Oncol. 2015;22(11):3474-3480.

Singh K, Lester J, Karlan B, et al. Impact of family history on choosing risk-reducing surgery among BRCA mutation carriers. Am J Obstet Gynecol. 2013;208(4):329-6.

Skytte AB, Cruger D, Gerster M, et al. Breast cancer after bilateral risk-reducing mastectomy. Clin Genet. 2011;79(5):431-437.

Skytte AB, Gerdes AM, Andersen MK, et al. Risk-reducing mastectomy and salpingo-oophorectomy in unaffected BRCA mutation carriers: uptake and timing. Clin Genet. 2010;77(4):342-349.

Society of Gynecologic Oncologists Clinical Practice Committee Statement on Prophylactic Salpingo-oophorectomy. Gynecol Oncol. 2005;98(2):179-81.

Spear SL, Carter ME, Schwarz K. Prophylactic mastectomy: Indications, options, and reconstructive alternatives. Plast Reconstr Surg. 2005;115(3):891-909.

Stuckey A, Dizon D, Scalia WJ, et al. Clinical characteristics and choices regarding risk-reducing surgery in BRCA mutation carriers. Gynecol Obstet Invest. 2010;69(4):270-273.

This P, de la RA, Savignoni A, et al. Breast and ovarian cancer risk management in a French cohort of 158 women carrying a BRCA1 or BRCA2 germline mutation: patient choices and outcome. Fam Cancer. 2012;11(3):473-482.

Tong A, Kelly S, Nusbaum R, et al. Intentions for risk-reducing surgery among high-risk women referred for BRCA1/BRCA2 genetic counseling. Psychooncology. 2015;24(1):33-39.

Tung N, Gaughan E, Hacker MR, et al. Outcome of triple negative breast cancer: comparison of sporadic and BRCA1-associated cancers. Breast Cancer Res Treat. 2014;146(1):175-182.

US Preventive Services Task Force (USPSTF). Genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility: recommendation statement. Ann Intern Med. 2005;143(5):355-61.

van Driel CM, de Bock GH, Arts HJ, et al. Stopping ovarian cancer screening in BRCA1/2 mutation carriers: Effects on risk management decisions & outcome of risk-reducing salpingo-oophorectomy specimens. Maturitas. 2015;80(3):318-322.

van Driel CM, Eltahir Y, de VJ, et al. Risk-reducing mastectomy in BRCA1/2 mutation carriers: factors influencing uptake and timing. Maturitas. 2014;77(2):180-184.

van Roosmalen MS, Verhoef LC, Peep PF, et al. Decision analysis of prophylactic surgery or screening for BRCA1 mutation carriers: a more prominent role for oophorectomy. J Clin Oncol. 2002;20(8):2092-2100.

van Verschuer V, Heemskerk-Gerritsen BA, van Deurzen CH, et al. Lower mitotic activity in BRCA1/2-associated primary breast cancers occurring after risk-reducing salpingo-oophorectomy. Cancer Biol Ther. 2014;15(4):371-379.

Vicus D, Shaw PA, Finch A, et al. Risk factors for non-invasive lesions of the fallopian tube in BRCA mutation carriers. Gynecol Oncol. 2010;118(3):295-298.

Vogel VG. Breast cancer prevention: a review of current evidence. CA Cancer J Clin. 2000;50(3):156-70.

Werner-Lin A, Hoskins LM, Doyle MH, et al. 'Cancer doesn't have an age': genetic testing and cancer risk management in BRCA1/2 mutation-positive women aged 18-24. Health (London). 2012;16(6):636-654.

Westin SN, Sun CC, Lu KH, et al. Satisfaction with ovarian carcinoma risk-reduction strategies among women at high risk for breast and ovarian carcinoma. Cancer. 2011;117(12):2659-2667.

Wethington SL, Park KJ, Soslow RA, et al. Clinical outcome of isolated serous tubal intraepithelial carcinomas (STIC). Int J Gynecol Cancer. 2013;23(9):1603-1611.

Wevers MR, Aaronson NK, Verhoef S, et al. Impact of rapid genetic counselling and testing on the decision to undergo immediate or delayed prophylactic mastectomy in newly diagnosed breast cancer patients: findings from a randomised controlled trial. Br J Cancer. 2014;110(4):1081-1087.

Wevers MR, Schmidt MK, Engelhardt EG, et al. Timing of risk reducing mastectomy in breast cancer patients carrying a BRCA1/2 mutation: retrospective data from the Dutch HEBON study. Fam Cancer. 2015;14(3):355-63.

Yao K, Liederbach E, Tang R, et al. Nipple-sparing mastectomy in BRCA1/2 mutation carriers: an interim analysis and review of the literature. Ann Surg Oncol. 2015;22(2):370-376.

Yao K, Winchester DJ, Czechura T, et al. Contralateral prophylactic mastectomy and survival: report from the National Cancer Data Base, 1998-2002. Breast Cancer Res Treat. 2013;142(3):465-476.

Yates MS, Meyer LA, Deavers MT, et al. Microscopic and early-stage ovarian cancers in BRCA1/2 mutation carriers: building a model for early BRCA-associated tumorigenesis. Cancer Prev Res (Phila). 2011;4(3):463-470.





Coding

Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.

The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.

CPT Procedure Code Number(s)

19303, 19304, 58150, 58180, 58262, 58263, 58291, 58542, 58544, 58552, 58554, 58571, 58573, 58661, 58720, 58940


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD - 10 Procedure Code Number(s)

N/A


Professional and outpatient claims with a date of service on or before September 30, 2015, must be billed using ICD-9 codes. Professional and outpatient claims with a date of service on or after October 1, 2015, must be billed using ICD-10 codes.

Facility/Institutional inpatient claims with a date of discharge on or before September 30, 2015, must be billed with ICD-9 codes. Facility/Institutional inpatient claims with a date of discharge on or after October 1, 2015, must be billed with ICD-10 codes.


ICD -10 Diagnosis Code Number(s)

N60.11 Diffuse cystic mastopathy of right breast

N60.12 Diffuse cystic mastopathy of left breast

N60.19 Diffuse cystic mastopathy of unspecified breast

N62 Hypertrophy of breast

N63.0 Unspecified lump in unspecified breast

N63.10 Unspecified lump in the right breast, unspecified quadrant

N63.11 Unspecified lump in the right breast, upper outer quadrant

N63.12 Unspecified lump in the right breast, upper inner quadrant

N63.13 Unspecified lump in the right breast, lower outer quadrant

N63.14 Unspecified lump in the right breast, lower inner quadrant

N63.20 Unspecified lump in the left breast, unspecified quadrant

N63.21 Unspecified lump in the left breast, upper outer quadrant

N63.22 Unspecified lump in the left breast, upper inner quadrant

N63.23 Unspecified lump in the left breast, lower outer quadrant

N63.24 Unspecified lump in the left breast, lower inner quadrant

N63.31 Unspecified lump in axillary tail of the right breast

N63.32 Unspecified lump in axillary tail of the left breast

N63.41 Unspecified lump in right breast, subareolar

N63.42 Unspecified lump in left breast, subareolar

Q85.8 Other phakomatoses, not elsewhere classified

Q87.89 Other specified congenital malformation syndromes, not elsewhere classified

R92.0 Mammographic microcalcification found on diagnostic imaging of breast

R92.1 Mammographic calcification found on diagnostic imaging of breast

R92.8 Other abnormal and inconclusive findings on diagnostic imaging of breast

Z15.01 Genetic susceptibility to malignant neoplasm of breast

Z15.02 Genetic susceptibility to malignant neoplasm of ovary

Z40.01 Encounter for prophylactic removal of breast

Z40.02 Encounter for prophylactic removal of ovary(s)

Z40.03 Encounter for prophylactic removal of fallopian tube(s)

Z80.0 Family history of malignant neoplasm of digestive organs

Z80.3 Family history of malignant neoplasm of breast

Z80.41 Family history of malignant neoplasm of ovary

Z84.81 Family history of carrier of genetic disease

Z85.3 Personal history of malignant neoplasm of breast

Z85.43 Personal history of malignant neoplasm of ovary

Z92.3 Personal history of irradiation



HCPCS Level II Code Number(s)

N/A


Revenue Code Number(s)

N/A

Coding and Billing Requirements


Cross References


Policy History

11.08.19m
04/10/2019The policy has been reviewed and reissued to communicate the Company's continuing position on Prophylactic Mastectomy, Oopherectomy/Salpingo-Oopherectomy, and Hysterectomy.


Effective 10/05/2017 this policy has been updated to the new policy template format.


Version Effective Date: 10/01/2017
Version Issued Date: 09/29/2017
Version Reissued Date: 04/10/2019

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2017 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.