Implementation of Risk-Reducing Surgery for HBOC Under Public Insurance in Japan: A Single-Center Experience

Implementation of Risk-Reducing Surgery for HBOC Under Public Insurance in Japan: A Single-Center Experience | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Implementation of Risk-Reducing Surgery for HBOC Under Public Insurance in Japan: A Single-Center Experience Hiroko Terui-Kohbata, Sayako Takahashi, Eriko Takamine, Mariko Komine, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7504978/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Oct, 2025 Read the published version in Familial Cancer → Version 1 posted 7 You are reading this latest preprint version Abstract Background: In Japan, BRCA1/2 genetic testing and risk-reducing surgeries for hereditary breast and ovarian cancer (HBOC) became covered by public insurance in 2018 and 2020, respectively. These policy changes have improved access to preventive care by lowering financial barriers. This study examined the clinical uptake and timing of risk-reducing salpingo-oophorectomy (RRSO) and mastectomy (RRM) among women with HBOC. Methods: We retrospectively reviewed clinical records of HBOC patients who underwent RRSO and/or RRM under public insurance at a single institution between April 2020 and December 2024. Descriptive statistics and chi-square tests were performed. Results: Among 23 women, 15 (65.2%) underwent RRM, 18 (78.3%) underwent RRSO, and 10 (43.5%) received both. All had a history of breast cancer but had not developed ovarian cancer. The average interval from HBOC diagnosis to surgery was 6.5 months for RRM and 11.3 months for RRSO. BRCA2 carriers had significantly longer delays to RRSO than BRCA1 carriers (p = .02). Three women deferred RRSO due to desire for childbearing. Conclusion: Insurance coverage facilitated preventive surgery uptake, underscoring the need for individualized counseling, particularly for BRCA2 carriers. hereditary breast and ovarian cancer BRCA1/2 risk-reducing mastectomy risk-reducing salpingo-oophorectomy insurance coverage Introduction In Japan, BRCA1/2 genetic testing was publicly insured in 2018, followed by risk-reducing salpingo-oophorectomy (RRSO) in 2020 and risk-reducing mastectomy (RRM) in 2022. These policy changes significantly expanded access to hereditary cancer prevention. However, uptake and timing of these procedures remain influenced by clinical and personal factors. This study evaluated the implementation of RRM and RRSO under insurance coverage at a single center. Methods We retrospectively reviewed clinical records of HBOC patients who underwent RRSO and/or RRM between April 2020 and December 2024. Descriptive statistics and chi-square tests were applied. Institutional ethics approval was obtained. Results Implementation of RRM and RRSO During the study period, a total of 23 women with hereditary breast and ovarian cancer syndrome (HBOC) underwent risk-reducing surgery (RRM and/or RRSO) under the Japanese public health insurance system at Institute of Science Tokyo Hospital. All 23 patients had a history of breast cancer but had not developed ovarian cancer at the time of surgery. Among them, 15 patients (65.2%) underwent RRM, 18 patients (78.3%) underwent RRSO, and 10 patients (43.5%) received both procedures (Table 1 ). Table 1 Characteristics of RRM and RRSO Patients by BRCA Status RRM ( N = 15) p -value RRSO ( N = 18) p -value BRCA1 n = 7 BRCA2 n = 8 BRCA1 n = 7 BRCA2 n = 11 Age at HBOC diagnosis Mean 46.0 42.9 0.65 46.6 46.5 0.12 Median 44.0 39.0 44.0 46.0 Min–Max 34–65 34–65 34–65 38–59 Age at surgery Mean 46.8 43.3 0.72 47.3 47.7 0.09 Median 45.0 39.0 45.0 47.5 Min–Max 39–65 39–66 35–65 39–59 Time from HBOC diagnosis to surgery Mean 6.5 6.4 0.71 6.4 15.2 0.02 Median 7.5 6.0 6.0 12.5 Min–Max 1–11 1–15 2–12 2–43 Of the 19 women diagnosed with HBOC at the Department of Medical Genetics, 10 patients (52.6%) ultimately underwent preventive surgery. Notably, four patients were diagnosed with HBOC through non-insured (self-funded) genetic testing, and all four cited the subsequent insurance coverage of these procedures as a primary factor in their decision to proceed with preventing surgery. The mean age at RRM was 45.1 years (median: 41.0 years; range: 34–66), and the mean age at RRSO was 47.4 years (median: 47.5 years; range: 34–65). No significant differences in age at surgery were observed between RRM and RRSO, nor between BRCA1 and BRCA2 carriers. The mean interval from HBOC diagnosis to surgery was 6.5 months (median: 7.0 months; range: 1–15) for RRM, and 11.3 months (median: 7.0 months; range: 2–43) for RRSO. While no significant difference was found between the two groups overall, further analysis revealed that the time to RRSO was significantly longer in BRCA2 carriers than in BRCA1 carriers (BRCA1: 6.4 months; BRCA2: 15.2 months; t-test: p = .02). Deferred RRSO Due to Desire for Childbearing Among the patients who wished to undergo RRSO but had not yet done so, all cases (3/3) cited future childbearing as the reason for deferral (Table 2 ). Two of them were unmarried at the time of HBOC diagnosis but had partners with whom they were planning to conceive, and some of the retrieved oocytes were cryopreserved as fertilized embryos. Table 2 Clinical Background of Patients Patient History BRCA1/2 pathogenic variant Age at HBOC Dx Family History Marital/Child Status RRM Status / Post-Diagnosis Course A Breast cancer (33y) BRCA1 34y Maternal side: Great-aunt (ovarian cancer, age 70) Unmarried / No children CRRM at time of primary surgery. First child born ~ 5 years after diagnosis. Considering RRSO by year-end. B Breast cancer (33y) BRCA2 33y Maternal side: Mother (breast cancer at 40), aunt (40s), cousin (40) Unmarried / No children CRRM performed 6 months after primary surgery with implant replacement. 2.5 years post-op, tamoxifen paused for pregnancy. C Breast cancer (34y) BRCA2 35y Paternal side: Aunt (breast cancer at 50, 55) Married / 1 child CRRM performed at time of primary surgery. 1.5 years post-op, chemotherapy ongoing. Discussion Our findings demonstrate that public insurance coverage greatly facilitated the uptake of preventive surgery among HBOC women, with just over half undergoing RRSO and/or RRM. Notably, BRCA2 carriers experienced longer delays before RRSO, potentially due to later ovarian cancer onset and fertility considerations ( 1 ). At our institution, only one to two RRSO procedures were performed annually before 2020, but the number increased markedly after insurance coverage. In contrast, RRM had rarely been performed prior to 2022 because the out-of-pocket cost, including reconstruction, exceeded one million JPY. Insurance reimbursement thus played a pivotal role in expanding access to both procedures. These results align with previous reports showing increased uptake after policy changes ( 2 , 3 ). The variability in timing underscores the importance of individualized counseling that integrates life planning, treatment status, and gene-specific risk. Broader multicenter studies are warranted to validate these findings. Conclusion Insurance coverage substantially increased uptake of RRM and RRSO in Japan. Delays among BRCA2 carriers highlight the importance of individualized decision-making. Declarations Author Contribution H.TK. wrote the main manuscript text and prepared tables. All authors reviewed the manuscript. References Rebbeck TR, Kauff ND, Domchek SM (2009) Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers. J Natl Cancer Inst 101(2):80–87 Abe A, Nomura H, Fusegi A et al (2024) Risk-reducing decisions regarding germline BRCA pathogenic variant: focusing on the timing of genetic testing and RRSO. J Med Genet 61(4):392–398 Konnai K, Fujiwara H, Kitagawa M et al (2023) Impact of lower co-payments on risk-reducing salpingo-oophorectomy and BRCA testing in Japan. Arch Public Health 81(1):32 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 16 Oct, 2025 Read the published version in Familial Cancer → Version 1 posted Editorial decision: Revision requested 25 Sep, 2025 Reviews received at journal 15 Sep, 2025 Reviewers agreed at journal 15 Sep, 2025 Reviewers invited by journal 14 Sep, 2025 Editor assigned by journal 02 Sep, 2025 Submission checks completed at journal 02 Sep, 2025 First submitted to journal 01 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7504978","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":516505493,"identity":"54fc4246-7786-467f-bdc8-a34a55c2923f","order_by":0,"name":"Hiroko Terui-Kohbata","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwUlEQVRIiWNgGAWjYBACCQYeNmYgLQfEBiABZqK1GPOQrCWxB6qFMJBs7z32uKDCLn2/2OENDD9qGNjNCWmR5jmXbjzjTHJuj3RaAWPPMQZmywYCWuQkcsykedsOALXkGDDwNjAwGxwgSsu/A+k8QC2Mf4nRIg3W0nAgAaSFmShbJHvOmBvPOJZs2HM7reCwzDEJwn6RON5j9rigxk6efXbyxodvamySCYYYCgA6SSKZyNhBAnakaxkFo2AUjILhDgDoqzXEEt6FKgAAAABJRU5ErkJggg==","orcid":"","institution":"Institute of Science Tokyo Hospital","correspondingAuthor":true,"prefix":"","firstName":"Hiroko","middleName":"","lastName":"Terui-Kohbata","suffix":""},{"id":516505494,"identity":"f6219f8e-3d18-4c2e-b0bb-ce15e7476ad6","order_by":1,"name":"Sayako Takahashi","email":"","orcid":"","institution":"Institute of Science Tokyo Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sayako","middleName":"","lastName":"Takahashi","suffix":""},{"id":516505495,"identity":"d797da6b-b7c5-4a45-9953-2959753e528c","order_by":2,"name":"Eriko Takamine","email":"","orcid":"","institution":"Institute of Science Tokyo Hospital","correspondingAuthor":false,"prefix":"","firstName":"Eriko","middleName":"","lastName":"Takamine","suffix":""},{"id":516505497,"identity":"a5c5cf24-6f74-467d-a9eb-2a9a59d11818","order_by":3,"name":"Mariko Komine","email":"","orcid":"","institution":"Institute of Science Tokyo Hospital","correspondingAuthor":false,"prefix":"","firstName":"Mariko","middleName":"","lastName":"Komine","suffix":""},{"id":516505498,"identity":"b36f1960-616d-439b-857c-9f844215072b","order_by":4,"name":"Maki Gau","email":"","orcid":"","institution":"Institute of Science Tokyo Hospital","correspondingAuthor":false,"prefix":"","firstName":"Maki","middleName":"","lastName":"Gau","suffix":""},{"id":516505499,"identity":"49063dd6-c146-409c-a51d-1617dfe0a117","order_by":5,"name":"Makiko Egawa","email":"","orcid":"","institution":"Institute of Science Tokyo Hospital","correspondingAuthor":false,"prefix":"","firstName":"Makiko","middleName":"","lastName":"Egawa","suffix":""},{"id":516505500,"identity":"9053739c-24e4-49df-87dd-c4e134856606","order_by":6,"name":"Yusuke Ebana","email":"","orcid":"","institution":"Institute of Science Tokyo Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yusuke","middleName":"","lastName":"Ebana","suffix":""},{"id":516505501,"identity":"23e0a5cf-5b0a-4b75-a976-76deb36400cc","order_by":7,"name":"Tomoyuki Aruga","email":"","orcid":"","institution":"Institute of Science Tokyo Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tomoyuki","middleName":"","lastName":"Aruga","suffix":""},{"id":516505502,"identity":"4bf68d33-af85-4655-b667-15b2d038d41c","order_by":8,"name":"Kimio Wakana","email":"","orcid":"","institution":"Institute of Science Tokyo Hospital","correspondingAuthor":false,"prefix":"","firstName":"Kimio","middleName":"","lastName":"Wakana","suffix":""},{"id":516505503,"identity":"7be4d1da-8d56-4aef-8c9b-fcfc3893b256","order_by":9,"name":"Masayuki Yoshida","email":"","orcid":"","institution":"Institute of Science Tokyo Hospital","correspondingAuthor":false,"prefix":"","firstName":"Masayuki","middleName":"","lastName":"Yoshida","suffix":""}],"badges":[],"createdAt":"2025-09-01 06:38:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7504978/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7504978/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s10689-025-00501-8","type":"published","date":"2025-10-16T15:57:58+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":91876952,"identity":"9efe598d-b3fe-4d01-8ba0-1805ca471f92","added_by":"auto","created_at":"2025-09-22 14:35:47","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":39496,"visible":true,"origin":"","legend":"","description":"","filename":"BriefReportRRMandRRSOFamCan0826.docx","url":"https://assets-eu.researchsquare.com/files/rs-7504978/v1/910b9ac373ac8b8fd7ebc56a.docx"},{"id":91876949,"identity":"16ac269c-242f-4009-ba12-532f30b0d192","added_by":"auto","created_at":"2025-09-22 14:35:47","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9702,"visible":true,"origin":"","legend":"","description":"","filename":"3cf7be0b428f43e3a46df7ce4efa22e8.json","url":"https://assets-eu.researchsquare.com/files/rs-7504978/v1/760ebaea8eb8fc2d9f6c84a2.json"},{"id":91876951,"identity":"8cc8a9eb-1d3d-4294-9cf6-d7e0655fb4ef","added_by":"auto","created_at":"2025-09-22 14:35:47","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":30674,"visible":true,"origin":"","legend":"","description":"","filename":"3cf7be0b428f43e3a46df7ce4efa22e81enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7504978/v1/233c144b95a99c8903bfb6f3.xml"},{"id":91876950,"identity":"31b7e222-1e85-4d4d-af57-c22f8ad1fc26","added_by":"auto","created_at":"2025-09-22 14:35:47","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":28558,"visible":true,"origin":"","legend":"","description":"","filename":"3cf7be0b428f43e3a46df7ce4efa22e81structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7504978/v1/fdb70b067240fc2159c34d3c.xml"},{"id":91878751,"identity":"730f6d24-328d-4beb-812c-e18a360c331d","added_by":"auto","created_at":"2025-09-22 14:43:47","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":35732,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7504978/v1/2732aebd405fa4f9b7651488.html"},{"id":93956036,"identity":"1f23df44-d3a0-4e65-9ce2-2097ef25eea1","added_by":"auto","created_at":"2025-10-20 16:09:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":501653,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7504978/v1/59801a2d-ce37-4793-ac7c-952fe22e379a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Implementation of Risk-Reducing Surgery for HBOC Under Public Insurance in Japan: A Single-Center Experience","fulltext":[{"header":"Introduction","content":"\u003cp\u003e In Japan, BRCA1/2 genetic testing was publicly insured in 2018, followed by risk-reducing salpingo-oophorectomy (RRSO) in 2020 and risk-reducing mastectomy (RRM) in 2022. These policy changes significantly expanded access to hereditary cancer prevention. However, uptake and timing of these procedures remain influenced by clinical and personal factors. This study evaluated the implementation of RRM and RRSO under insurance coverage at a single center.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e We retrospectively reviewed clinical records of HBOC patients who underwent RRSO and/or RRM between April 2020 and December 2024. Descriptive statistics and chi-square tests were applied. Institutional ethics approval was obtained.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eImplementation of RRM and RRSO\u003c/h2\u003e\u003cp\u003eDuring the study period, a total of 23 women with hereditary breast and ovarian cancer syndrome (HBOC) underwent risk-reducing surgery (RRM and/or RRSO) under the Japanese public health insurance system at Institute of Science Tokyo Hospital. All 23 patients had a history of breast cancer but had not developed ovarian cancer at the time of surgery. Among them, 15 patients (65.2%) underwent RRM, 18 patients (78.3%) underwent RRSO, and 10 patients (43.5%) received both procedures (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of RRM and RRSO Patients by BRCA Status\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eRRM (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;15)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003eRRSO (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;18)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBRCA1\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBRCA2\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eBRCA1\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;7\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eBRCA2\u003c/p\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;11\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge at HBOC diagnosis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e46.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e46.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.12\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e44.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e46.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMin\u0026ndash;Max\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34\u0026ndash;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34\u0026ndash;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34\u0026ndash;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e38\u0026ndash;59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge at surgery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e47.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e47.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e45.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e47.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMin\u0026ndash;Max\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39\u0026ndash;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e39\u0026ndash;66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e35\u0026ndash;65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e39\u0026ndash;59\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTime from HBOC diagnosis to surgery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e15.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e6.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMin\u0026ndash;Max\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u0026ndash;11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u0026ndash;15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u0026ndash;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2\u0026ndash;43\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eOf the 19 women diagnosed with HBOC at the Department of Medical Genetics, 10 patients (52.6%) ultimately underwent preventive surgery. Notably, four patients were diagnosed with HBOC through non-insured (self-funded) genetic testing, and all four cited the subsequent insurance coverage of these procedures as a primary factor in their decision to proceed with preventing surgery.\u003c/p\u003e\u003cp\u003eThe mean age at RRM was 45.1 years (median: 41.0 years; range: 34\u0026ndash;66), and the mean age at RRSO was 47.4 years (median: 47.5 years; range: 34\u0026ndash;65). No significant differences in age at surgery were observed between RRM and RRSO, nor between BRCA1 and BRCA2 carriers.\u003c/p\u003e\u003cp\u003eThe mean interval from HBOC diagnosis to surgery was 6.5 months (median: 7.0 months; range: 1\u0026ndash;15) for RRM, and 11.3 months (median: 7.0 months; range: 2\u0026ndash;43) for RRSO. While no significant difference was found between the two groups overall, further analysis revealed that the time to RRSO was significantly longer in BRCA2 carriers than in BRCA1 carriers (BRCA1: 6.4 months; BRCA2: 15.2 months; t-test: p\u0026thinsp;=\u0026thinsp;.02).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDeferred RRSO Due to Desire for Childbearing\u003c/h3\u003e\n\u003cp\u003eAmong the patients who wished to undergo RRSO but had not yet done so, all cases (3/3) cited future childbearing as the reason for deferral (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Two of them were unmarried at the time of HBOC diagnosis but had partners with whom they were planning to conceive, and some of the retrieved oocytes were cryopreserved as fertilized embryos.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClinical Background of Patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHistory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBRCA1/2 pathogenic variant\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAge at HBOC Dx\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFamily History\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMarital/Child Status\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eRRM Status / Post-Diagnosis Course\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBreast cancer (33y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBRCA1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e34y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMaternal side: Great-aunt (ovarian cancer, age 70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUnmarried / No children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCRRM at time of primary surgery. First child born\u0026thinsp;~\u0026thinsp;5 years after diagnosis. Considering RRSO by year-end.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eB\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBreast cancer (33y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBRCA2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e33y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMaternal side: Mother (breast cancer at 40), aunt (40s), cousin (40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eUnmarried / No children\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCRRM performed 6 months after primary surgery with implant replacement. 2.5 years post-op, tamoxifen paused for pregnancy.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eC\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBreast cancer (34y)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBRCA2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35y\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePaternal side: Aunt (breast cancer at 50, 55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMarried / 1 child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eCRRM performed at time of primary surgery. 1.5 years post-op, chemotherapy ongoing.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings demonstrate that public insurance coverage greatly facilitated the uptake of preventive surgery among HBOC women, with just over half undergoing RRSO and/or RRM. Notably, \u003cem\u003eBRCA2\u003c/em\u003e carriers experienced longer delays before RRSO, potentially due to later ovarian cancer onset and fertility considerations (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAt our institution, only one to two RRSO procedures were performed annually before 2020, but the number increased markedly after insurance coverage. In contrast, RRM had rarely been performed prior to 2022 because the out-of-pocket cost, including reconstruction, exceeded one million JPY. Insurance reimbursement thus played a pivotal role in expanding access to both procedures. These results align with previous reports showing increased uptake after policy changes (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe variability in timing underscores the importance of individualized counseling that integrates life planning, treatment status, and gene-specific risk. Broader multicenter studies are warranted to validate these findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eInsurance coverage substantially increased uptake of RRM and RRSO in Japan. Delays among BRCA2 carriers highlight the importance of individualized decision-making.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eH.TK. wrote the main manuscript text and prepared tables. All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRebbeck TR, Kauff ND, Domchek SM (2009) Meta-analysis of risk reduction estimates associated with risk-reducing salpingo-oophorectomy in BRCA1 or BRCA2 mutation carriers. J Natl Cancer Inst 101(2):80\u0026ndash;87\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbe A, Nomura H, Fusegi A et al (2024) Risk-reducing decisions regarding germline BRCA pathogenic variant: focusing on the timing of genetic testing and RRSO. J Med Genet 61(4):392\u0026ndash;398\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKonnai K, Fujiwara H, Kitagawa M et al (2023) Impact of lower co-payments on risk-reducing salpingo-oophorectomy and BRCA testing in Japan. Arch Public Health 81(1):32\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"familial-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"fame","sideBox":"Learn more about [Familial Cancer](http://link.springer.com/journal/10689)","snPcode":"10689","submissionUrl":"https://submission.nature.com/new-submission/10689/3","title":"Familial Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"hereditary breast and ovarian cancer, BRCA1/2, risk-reducing mastectomy, risk-reducing salpingo-oophorectomy, insurance coverage","lastPublishedDoi":"10.21203/rs.3.rs-7504978/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7504978/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eIn Japan, BRCA1/2 genetic testing and risk-reducing surgeries for hereditary breast and ovarian cancer (HBOC) became covered by public insurance in 2018 and 2020, respectively. These policy changes have improved access to preventive care by lowering financial barriers. This study examined the clinical uptake and timing of risk-reducing salpingo-oophorectomy (RRSO) and mastectomy (RRM) among women with HBOC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe retrospectively reviewed clinical records of HBOC patients who underwent RRSO and/or RRM under public insurance at a single institution between April 2020 and December 2024. Descriptive statistics and chi-square tests were performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAmong 23 women, 15 (65.2%) underwent RRM, 18 (78.3%) underwent RRSO, and 10 (43.5%) received both. All had a history of breast cancer but had not developed ovarian cancer. The average interval from HBOC diagnosis to surgery was 6.5 months for RRM and 11.3 months for RRSO. BRCA2 carriers had significantly longer delays to RRSO than BRCA1 carriers (p = .02). Three women deferred RRSO due to desire for childbearing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eInsurance coverage facilitated preventive surgery uptake, underscoring the need for individualized counseling, particularly for BRCA2 carriers.\u003c/p\u003e","manuscriptTitle":"Implementation of Risk-Reducing Surgery for HBOC Under Public Insurance in Japan: A Single-Center Experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-22 14:35:43","doi":"10.21203/rs.3.rs-7504978/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-25T11:44:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-15T19:29:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65565687455870349447523991307933034972","date":"2025-09-15T16:19:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-14T12:21:38+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-02T06:37:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-02T06:35:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"Familial Cancer","date":"2025-09-01T06:32:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"familial-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"fame","sideBox":"Learn more about [Familial Cancer](http://link.springer.com/journal/10689)","snPcode":"10689","submissionUrl":"https://submission.nature.com/new-submission/10689/3","title":"Familial Cancer","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"929a37b9-f2c8-45de-aae7-1623d3976533","owner":[],"postedDate":"September 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-10-20T16:02:50+00:00","versionOfRecord":{"articleIdentity":"rs-7504978","link":"https://doi.org/10.1007/s10689-025-00501-8","journal":{"identity":"familial-cancer","isVorOnly":false,"title":"Familial Cancer"},"publishedOn":"2025-10-16 15:57:58","publishedOnDateReadable":"October 16th, 2025"},"versionCreatedAt":"2025-09-22 14:35:43","video":"","vorDoi":"10.1007/s10689-025-00501-8","vorDoiUrl":"https://doi.org/10.1007/s10689-025-00501-8","workflowStages":[]},"version":"v1","identity":"rs-7504978","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7504978","identity":"rs-7504978","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}