As the testing criteria for BRCA expand, we are identifying a greater number of young women at significant risk for breast and ovarian cancer. Fortunately, there is strong evidence to support risk reduction from mastectomy and oophorectomy. However, these surgeries come with significant psychological and physical health consequences. For breast cancer, screening with mammogram and magnetic resonance imaging may be a reasonable approach for a woman who does not desire surgery. However, there is no evidence to suggest any efficacy in screening for ovarian cancer, and women electing to not undergo surgery must have a detailed discussion with their physician regarding the risks and benefits of different management strategies. As more women are electing to undergo surgical risk reduction, providers must also be able to counsel and care for these women who will face unique health challenges after surgical menopause at a young age. A review of the current evidence behind management of the BRCA woman follows, with a focus on areas of controversy and current research.
Obstetricians and gynecologists, family physicians
After completing this CME activity, physicians should be better able to summarize the common criteria for referring a women for genetic testing for hereditary breast/ovarian cancer, illustrate the cancer risks and other associated cancers based on BRCA1 or BRCA2 result; provide evidence-based guidelines from which to base management discussions with women testing positive for a BRCA mutation; and highlight areas of controversy including the role of concurrent hysterectomy with risk-reducing salpingo-oophorectomy, role for salpingectomy, use of hormonal replacement therapy, and management of long-term health outcomes following risk-reducing salpingo-oophorectomy.