However, the 2-stage approach, compared with hyst-BSO at age 40 years, was associated with increased cancer incidence that varied by gene variant (MLH1: 7.76% vs 3.84%; MSH6: 7.24% vs 4.52%) and increased cancer mortality that varied by gene variant (MLH1: 5.74% vs 2.55%; MSH6: 5.22% vs 2.97%) (Table 3; eFigure 3 and eTable 4 in the Supplement). The gene discussed is MSH6; the disease is cancer.