High Risk Surveillance

Due to the high risk of breast and ovarian cancer, most will recommend mastectomies and then ovary and tube removal as soon as child bearing is completed. This is the greatest risk reduction but is still not 100%. There is no consensus on how to follow patients with mutations regardless of cancer diagnosis or not. The NCI is currently doing clinical trials for patients with known mutations to try and answer this question. Here's a link: http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA#a18 Due to the high risk of breast and ovarian cancer, most will recommend mastectomies and then ovary and tube removal as soon as child bearing is completed. This is the greatest risk reduction but is still not 100%. There is no consensus on how to follow patients with mutations regardless of cancer diagnosis or not. The NCI is currently doing clinical trials for patients with known mutations to try and answer this question. Here's a link: http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA#a18

Risk stratification based upon family history and established risk factors is essential. There are models such as the GAIL model which can calculate risk based upon age, age of menarche, age first live birth, # first degree relatives with breast cancer, hx breast biopsies and finding of atypia. For patients determined to be at high risk, genetic counseling to discuss possible benefit of BRCA testing is important. Surveillance may include self, exam, clinical breast exam, mammography, ultrasound and MRI depending on the level of risk. Risk stratification based upon family history and established risk factors is essential. There are models such as the GAIL model which can calculate risk based upon age, age of menarche, age first live birth, # first degree relatives with breast cancer, hx breast biopsies and finding of atypia. For patients determined to be at high risk, genetic counseling to discuss possible benefit of BRCA testing is important. Surveillance may include self, exam, clinical breast exam, mammography, ultrasound and MRI depending on the level of risk.