Transcript Related Guidelines

What Surveillance Would You Recommend to a Patient with a BRCA Mutation Who Declines Prophylactic Surgery?

Susan Domchek, MD · Basser Center for BRCA

Disclosures

December 27, 2019

This transcript has been edited for clarity.

For BRCA1 and 2 mutation carriers, two of the biggest risks are breast and ovarian cancer. The lifetime risk of breast cancer is up to 70% in women who have BRCA1 or BRCA2 germline mutations, and in those women, the two options are either to consider a preventive or prophylactic mastectomy or to consider enhanced breast screening.[1,2]For those who choose breast screening, we start breast magnetic resonance imaging (MRI) at 25. And then at 30, we add on a mammogram so that a woman is getting either an MRI or a mammogram every 6 months.  For ovarian cancer risk, screening doesn't work particularly well,[3,4]although we do talk about screening with transvaginal ultrasound and cancer antigen (CA)-125 blood tests. But mostly we talk about preventative removal of the ovary between 35 and 40 for BRCA1 and 40 to 45 for BRCA2 mutation carriers.[5]

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