The U.S. Preventive Service Task Force (USPSTF) evaluates evidence and provides screening guidelines for a number of diseases, including breast cancer. It has just updated its previous guidelines for breast cancer screening in women who have no personal history of cancer, but have a family history that indicates an increased likelihood of especially dangerous BRCA-related cancers. The updated recommendations were published online in The Annals of Internal Medicine.
Under the new guidelines, women from families with the following histories would warrant special attention: A breast cancer diagnosis before age 50; bilateral breast cancer; breast and ovarian cancer; the presence of breast cancer in one or more male family members; multiple cases of breast cancer; one or more family member with 2 primary types of BRCA-related cancer; being of Ashkenazi Jewish ethnicity.
The new guidelines provide information about screening tests that a primary care physician or other healthcare provider can use to assess whether a woman is likely to have an increased risk for potentially harmful mutations. Such women would then have genetic counseling, and then perhaps genetic testing for the BRCA mutations.
If a woman does carry a BRCA mutation, the recommendations would then be for earlier, more frequent or intensive cancer screenings; prescription of medications such as tamoxifen or raloxifene, which have been shown to reduce the risk of cancer; and/or surgery mastectomy or removal of the ovaries.
For women without a suspicious family history, the USPSTF emphasized that genetic testing and early intervention may not be warranted -- and could even be harmful by subjecting women to unnecessary procedures and anxiety.
ACSH s Dr Ruth Kava comments: These guidelines clarify which women are most, and least, likely to benefit from more intensive screening and treatment. Adherence to such recommendations is likely to prevent or catch BRCA-related cancers early, as well as to help avoid anxiety-producing testing when it is not indicated.
