<h3>Objectives:</h3> Rates of referral to genetic counseling are low for women of color and lower socioeconomic status, and these women are underrepresented in studies examining decisional factors related to uptake of risk-reducing bilateral salpingo-oophorectomy (rrBSO) in patients with pathogenic <i>BRCA1</i> or <i>BRCA2</i> mutations. To address this gap in the literature, our objective is to report adherence to evidence-based guidelines for rrBSO recommendation and uptake among <i>BRCA1</i> and <i>BRCA2</i> mutation carriers at an urban, public academic center whose population is racially and socioeconomically diverse, and to identify any association of sociodemographic variables with rrBSO uptake. <h3>Methods:</h3> This is an IRB-approved retrospective cohort study of <i>BRCA1</i> and <i>BRCA2</i> mutation carriers eligible for rrBSO by NCCN guidelines presenting from January 1, 2008 to December 31, 2019. Demographic and clinical data were collected from electronic medical records. Zip codes and census data were used as surrogate determinants for neighborhood exposure to poverty, unemployment, food security and violent crime. Differences between groups were determined by Chi-square analyses and associations determined by logistic regression modeling. <h3>Results:</h3> The study population was made up of 167 eligible patients, 39% of whom were Black (n=65), 35% Caucasian (n=59), 19% Hispanic (n=32), and 7% self-identified as ‘other' race. Less than 5% of patients reported known Ashkenazi Jewish heritage. Approximately half carried either <i>BRCA1</i> (51%, n=86) or <i>BRCA2</i> (46%, n=77) mutations (unspecified <i>BRCA</i> mutation, n=4). Over 95% (n=159) received the recommendation for age-appropriate rrBSO, and 52% (n=87) underwent the surgery. Women who had rrBSO were older, with 56% being 50 years or older at the time of the study (n=49), compared to 35% in the group who had not undergone the surgery (n=28, p=0.0058). There were no other differences between groups (Table 1). Black race (OR 3.70, 95% CI 1.02 - 13.46) was associated with uptake of rrBSO, as were lower rates of unemployment (continuous OR 1.18, 95% CI 1.03 - 1.35), and documented recommendation for rrBSO (OR 56.01, 95% CI 3.42 - 917.43). There was no significant association between rrBSO uptake and mutation type, age, parity, insurance type, level of education, neighborhood poverty, food security or violent crime, personal history of breast cancer, or family history of ovarian or other <i>BRCA-</i>related cancers. <h3>Conclusions:</h3> This study demonstrates that the majority of <i>BRCA1</i> and <i>BRCA2</i> carriers at an urban, public hospital received the recommendation for age-appropriate rrBSO. Black race and lower unemployment were associated rrBSO uptake. Genetic counseling was associated with adherence to evidence-based guidelines for the recommendation, as well as patients' odds of having the surgery. Future qualitative studies will report decisional factors in this diverse population.