The American College of Obstetricians and Gynecologists (ACOG) has recently updated its clinical guidelines for the management of hereditary breast and ovarian cancer syndrome.
The most common causes of hereditary breast and ovarian cancer syndrome are BRCA1 and BRCA2 mutations, which account for 4% of breast cancer cases and approximately 24% of epithelial ovarian cancer cases. The estimated risk for breast cancer by age 70 is 45% to 85% among carriers of BRCA1 and/or BRCA2, and the estimated risk for ovarian cancer is 39% to 46% among BRCA1 carriers and 10% to 27% among BRCA2 carriers.
In order to better manage the risks associated with BRCA1 and BRCA2 mutations, the ACOG has made the following recommendations for the management of hereditary breast and ovarian cancer syndrome:
- All women with epithelial ovarian cancer, including fallopian tube and primary peritoneal cancer, should be offered genetic counseling.
- When counseling indicates an inherited cancer syndrome, genetic testing should be offered.
- Routine screening with cancer antigen 125 measurement or transvaginal ultrasound is not recommended in BRCA mutation carriers or women with personal or family histories of ovarian cancer.
- Breast cancer surveillance for mutation carriers varies by age.
- Women ages 25 to 29 years should receive a clinical breast examination every 6 to 12 months and breast imaging annually [ideally, magnetic resonance imaging with contrast].
- Women ages 30 years and older should receive annual mammography screening and MRI, alternating every 6 months
- Risk-reducing bilateral mastectomy and bilateral salpingo-oophorectomy should be offered to BRCA mutation carriers.
- Salpingo-oophorectomy is recommended at ages 35 to 40 years for BRCA1 mutation carriers and at ages 40 to 45 years for BRCA2 mutation carriers.