Issue link: https://viewer.e-digitaledition.com/i/1331050
Recommendations BY CARI WADE GERVIN REASSESSING NE W GUIDELINES ON HOW TO TRE AT HEREDITARY BRE A ST CANCER COULD BE A GAMECHANGER. Mandatory Mastectomy REASSESSING IN EARLY APRIL, the American Society of Clinical Oncology, American Society for Radiation Oncology and the Society of Surgical Oncology released the first- ever guidelines on how best to manage patients with hereditary breast cancer, from the perspective of both local and systemic management. According to Nadine M. Tung, MD, the study's lead author, the new guidelines could result in less women with BRCA1 and BRCA2 mutations having preventative double mastectomies. Dr. Tung has worked in oncology for 30 years and studied genetic testing for the past 20 years. "Prior to these guidelines, I would often hear that patients with BRCA mutations must have bilateral mastectomies," says Dr. Tung, who is an associate professor at Harvard Medical School and the Director of the Cancer Risk and Prevention Program at Beth Israel Deaconess Medical Center. "For a 60-year-old mutation carrier with her first breast cancer, I think that a woman has a choice and should be informed of her risk of a second contralateral breast cancer in order to help her make the most evidence-based choice and the one that is right for her." The full guidelines, published in the Journal of Clinical Oncology, include detailed recommendations for a multi- tude of clinical questions and explain the research assessed for each. However, it was limited to the five most common genes for which inherited mutations are associ- ated with breast cancer: BRCA1, BRCA2, PALB2, CHEK2 and ATM. The guidelines include tables that assess the risk for BRCA mutation carriers based on age at diagnosis. Other factors that should be weighed include a woman's ability to get an annual breast MRI, her prognosis, other comorbidities and her ability to receive chemotherapy. "With annual breast MRI and mam- mogram surveillance, for those women who choose to keep their breasts, early detection of future breast cancer is quite feasible," Dr. Tung says. "Making this difficult decision starts by understanding what a woman's risk of a second breast cancer is." Although many patients will still need bilateral mastectomy based on the above factors or because it decreases the risk of subsequent breast cancer, Dr. Tung says their research found insufficient data that there is an overall survival benefit for BRCA1 or BRCA2 mutation carriers who receive the procedure. "Thus, the committee concluded that breast-conser ving therapy should be offered as an option if appropriate and desired," Dr. Tung says. The g uidelines a lso recommend that brea st ca ncer patients w ith the more SPECIAL CLINICAL SECTION: ONCOLOGY 2 2