1533 Background: Laparoscopic bilateral salpingo-ophorectomy (BSO) is playing an increasing role in the management of breast cancer in BRCA positive women. Those undergoing prophylactic BSO have decreased risk of breast cancer recurrence, ovarian cancer, and overall mortality (Domcheck et al., JAMA 2010;304(9)). We have previously reported that timing of BRCA testing impacts surgical approach in breast cancer management (Trosman JR, ASCO-Abstract-666-2010). The study goals are to review a cohort of breast cancer patients electing prophylactic BSO, and evaluate BRCA test results, timing of genetic counseling and prophylactic surgery. Methods: This is a retrospective medical record review of 302 breast cancer patients with BRCA testing and definitive surgery between July 1st 2006 and September 1st 2010. Following an IRB protocol, we reviewed the clinical characteristics of this population and used simple frequencies and Fisher’s exact test to evaluate associations between BRCA results and salpingo-oophorectomy. Results: Sixty-seven women of a cohort of 302 (22%) underwent bilateral salpingo-oophorectomy, 49 of whom did so for primary prophylactic indications. Of these, 34 (69%) tested positive for the BRCA mutation. 79% (34/43) of BRCA positive women had salpingo-oophorectomy as compared to 6% (15/240) of BRCA negative patients, p<0.0001. Among BRCA positive women, 48% (11/23) counseled prior to breast cancer surgery had BSO compared to 66% (26/39) counseled afterward, p< 0.1840. Conclusions: Over 75% of BRCA positive women elected prophylactic bilateral salpingo-oophorectomy as compared to 6% of BRCA negative breast cancer patients. BRCA positive breast cancer patients counseled prior to breast cancer surgery were not more likely to opt for salpingo-oophorectomy than those counseled afterwards.