In women who are at an increased risk of inherited breast cancer and ovarian cancer, screening and prevention strategies can be instituted to reduce their risks, according to new clinical management guidelines from the American College of Obstetricians and Gynecologists (ACOG). The practice bulletin focuses on the primary genetic mutations associated with hereditary breast and ovarian cancer syndrome, BRCA1 and BRCA2, but also discusses some additional genes that have been implicated. Among the (Level B) recommendations:
- Genetic counseling is recommended for all women with ovarian epithelial cancer (this includes fallopian tube cancer or primary peritoneal cancer) and for individuals who have a personal or family history of breast cancer or ovarian cancer.
- Women with BRCA mutations or who carry another actionable deleterious mutation that is predisposing to breast cancer should be offered risk-reducing bilateral mastectomy.
- Women with BRCA mutations or who carry another actionable deleterious mutation predisposing to ovarian cancer should be offered risk-reducing bilateral salpingo-oophorectomy. The timing of risk-reducing bilateral salpingo-oophorectomy can be individualized based on the particular genetic mutation, the patient’s desires for future childbearing, and family history.
- For a risk-reducing bilateral salpingo-oophorectomy, all tissue from the ovaries and fallopian tubes should be removed.
Hereditary breast and ovarian cancer syndrome. Practice Bulletin No. 182. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2017:130:e110–26.