Management of Women at High Familial Risk of Breast and Ovarian Cancer
This article was first published in Cancer Forum: Clinical Cancer Genetics, Vol. 31, No. 3, November 2007 (by Cancer Council Australia). Reproduced with permission from the authors and publishers.
Women with a strong family history of breast and/or ovarian cancer have a greatly increased risk for the development of these diseases. The key question for these women is what they can do to ameliorate their cancer risk. Fortunately, there are now several interventions which clearly reduce breast and ovarian cancer risk in high-risk women. These include risk-reducing bilateral mastectomy, salpingo-oophorectomy and chemoprevention with tamoxifen or raloxifene. For those women who do not undergo risk-reducing bilateral mastectomy, screening is generally recommended in order to try and detect breast cancers at an early stage. Breast magnetic resonance imaging has an emerging role in such screening programs. Cancer screening does not reduce cancer risk and its impact on reduction of mortality in this group is uncertain. Women at high risk should be fully informed of their surgical, chemopreventive and screening options. A risk management plan should be tailored to each woman, particularly taking into account the level of her short-term (rather than lifetime) risk, her lifestyle plans (such as child-bearing), competing risks (particularly in women with a prior cancer) and her personal preferences. The risk management plan should be reviewed regularly and altered as the individual's short-term risk level and circumstances change, and as the evidence base for various interventions builds. Participation in appropriate clinical trials should be offered.
