Management of women with familial breast cancer risk.

17 May 2005

A recent publication in the European Journal of Cancer sets out guidelines for the management of women at increased risk of familial breast cancer [Sauven P (2004) Eur J Cancer 40, 653-665]. Commissioned by the Association of Breast Surgery, these guidelines were developed by a panel of experts from specialities including oncology, clinical and cancer genetics, radiology and clinical psychology, on behalf of the Association of Breast Surgery. Seven panel members are from the UK and two from the New York Strang Cancer Prevention Center, US. The guidelines are based on the UK model of healthcare, although the report states that the recommendations (summarised below) are intended to be more widely applicable.

Summary of recommendations

All Breast Units should have a protocol for the management of women at familial risk.

Women at potentially increased familial risk of breast cancer should be defined according to standard, moderate or high-risk groups.

Women who are eligible should be offered the opportunity to participate in prospective chemo-prevention studies.

Women at high-risk of familial breast cancer should be referred to a genetics clinic, according to an agreed protocol.

Risk-reducing mastectomy may significantly reduce, but not eliminate, the risk of subsequent breast cancer and should be offered to women where appropriate.

Units undertaking risk-reducing mastectomy should have agreed protocols.

Prophylactic oophorectomy should not be routinely recommended solely to reduce breast cancer risk.

Prophylactic oophorectomy should be discussed as an option to reduce ovarian cancer risk in BRCA1and BRCA2 carriers.

Mammographic screening of women at familial risk is of unproven benefit and should only be undertaken according to strict unit protocols or, preferably, within a clinical trial.

The functions of a Family History Clinic are outlined

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