NCCN Guidelines for Risk Management for Women with BRCA Mutations

Breast cancer screening:

• Learning to be aware of changes in breasts:
  • Beginning at age 18
• Clinical breast exam every 6 to 12 months:
  • Beginning at age 25
• Annual breast MRI with contrast (or mammogram if MRI is unavailable):
  • Beginning at age 25 
• Annual breast MRI with contrast and mammogram:
  • At ages 30 to 75
• Consider 3D mammography if available
• Screening after age 75 should be considered on an individual basis
• Consider participation in an imaging or screening clinical trial

Breast cancer risk reduction:

• Discussion of risk-reducing mastectomy
• Consider medication to reduce breast cancer risk

Ovarian cancer risk management:

• Risk-reducing removal of ovaries and fallopian tubes:
  • Between age 35 and 40
  • Upon completion of child bearing
• Delaying risk-reducing removal of ovaries and fallopian tubes unti:
  • Age 40 to 45 is “reasonable” for BRCA2 mutation carriers:
    • Because the average age of ovarian cancer onset is 8 to 10 years later than in BRCA1 mutation carriers
• Routine ovarian cancer screening using transvaginal ultrasound and a CA-125 blood test is “of uncertain benefit”:
  • But may be performed at the doctor’s discretion starting at age 30 to 35
• Removal of Fallopian tubes only (salpingectomy) is not standard of care for ovarian cancer risk reduction:
  • There are ongoing clinical trials studying salpingectomy in women at high risk of ovarian cancer

Pancreatic cancer:

Pancreatic cancer screening is done using two types of medical procedures: 

• Magnetic resonance cholangiopancreatography (MRCP)
• Endoscopic ultrasound (EUS)

Experts guidelines say:

• People with a mutation in BRCA1 or BRCA2 and those with a family history of pancreatic cancer, are encouraged to discuss the pros and cons of annual screening with their health care provider
• Experts do not currently recommend pancreatic cancer screening for people with a BRCA1 or BRCA2 mutation who do not have a close family history of pancreatic cancer
• For those who decide to undergo pancreatic cancer screening:
  • Consider beginning at age 50 or 10 years earlier than the earliest pancreatic cancer diagnosis in the family
• Screening should begin with:
  • Annual MRCP and/or EUS (both ideally performed at a center with expertise)

People with a BRCA1 or BRCA2 mutation may also be eligible for pancreatic cancer screening clinical trials.

Melanoma screening:

• Education regarding signs and symptoms of melanoma, especially those associated with BRCA gene pathogenic / likely pathogenic variants
• General melanoma risk management is appropriate:
  • Such as annual full-body skin examination and minimizing sun exposure

Reproductive options:

• For patients of reproductive age:
  • Advise about options for prenatal diagnosis and assisted reproduction including pre-implantation genetic diagnosis. 

Risk to relatives:

• Advise about possible inherited cancer risk to relatives, options for risk assessment, and management
• Recommend genetic counseling and consideration of genetic testing for at-risk relatives

• Rodrigo Arrangoiz MS, MD, FACS cirujano oncology y cirujano de mamá de Sociedad Quirúrgica S.C en el America British Cowdray Medical Center en la ciudad de Mexico:
  • Es experto en el manejo del cáncer de mama.

👉Es miembro de la American Society of Breast Surgeons:

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012

• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012

• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016

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