Current best practices and rationalistic perspectives in causation-based prevention, early detection and multidisciplinary treatment of breast and gastric cancer

Gastric & Breast Cancer e-journal
DOI: 10.2122/gbc.2006.0045


Choosing preventive intervention in an individual woman with a BRCA1 or BRCA2 mutation
Angelos M. Kappas, Dimosthenis Ziogas, Evangelos Paraskevaidis, Michael Fatouros, and Dimitrios H. Roukos*

A decade after the discovery of BRCA1 and BRCA2 genes, the evident very high lifetime risk for breast cancer (~80%) and ovarian cancer (11-55%) for mutation carriers, reveals the urgent need for live-saving preventive intervention.

Although scientific knowledge to achieve the goal of a 5-10% annual incidence reduction of breast cancer through identification and prevention of high-risk women exists, lack of good-quality evidence combined with limitations and adverse effects of both genetic testing and preventive interventions (surgical vs, nonsurgical) extremely complicate prevention decisions-making. In the absence of standard family-history and age-based criteria, decisions for offering genetic counselling and mutation testing should balance risks of missing young carriers and adverse effects. Most of these challenges can be resolved if primary care prevention strategy is orchestrated by specialized teams and a new algorithm meeting these requirements is proposed.

Although high-quality evidence is still lacking, prophylactic bilateral salpingo-oophorectomy (PBSO) after completion of childbearing (35 to 40 years), appears to be the optimal prevention as compared to bilateral mastectomy or nonsurgical prevention strategies. Chemoprevention and/or surveillance should be considered only for those women who reject prophylactic surgery.

Online ISSN : 1109 - 7647
   Print ISSN : 1109 - 7655

We subscribe to the HONcode principles of the HON Foundation. Click to verify. We subscribe to the HONcode principles. Verify here.
please, read our policy about privacy and confidentiality of information and transparency of sponsorship

last update: 22 May 2003