title: Recommendations for medical management of hereditary breast and ovarian cancer: the French National Ad Hoc Committee.
abstract: OBJECTIVE
  Almost 10% of breast and ovarian cancers are familial, and the majority are linked to BRCA1 and BRCA2 germline mutations. Despite uncertainty about the management of female gene carriers, consensus guidelines have been established to assist practitioners and consultees in making health care decisions.
  
  
  METHODS
  The Ad Hoc Committee was composed of 14 experts appointed by the French National Institute for Health and Medical Research, all of whom attended eleven workshops at which more than 3500 articles were systematically analyzed. Five additional experts critically analysed the first version of the report. CRITERIA AND DECISION PROCESS: On a probability scale of the risk of developing breast or ovarian cancers, two thresholds were defined for use in determining whether an intervention would be worthwhile. The first is the threshold above which an intervention can be envisaged or recommended, and the second is the one below which an intervention can be ruled out; between the two, the decision has to be made on a case-by-case basis. SCREENING AND PREVENTIVE STRATEGIES ANALYZED: With respect to breast cancer: 1) hormonal interventions; 2) primary prevention (diet, family planning and chemoprevention); 3) screening (breast self-examination, clinician breast examination, tumor markers, imaging); 4) prophylactic mastectomy. With respect to ovarian cancer: 1) hormonal stimulation; 2) screening (clinical screening, ultrasound and tumor markers); 3) prophylactic oophorectomy.
  
  
  CONCLUSIONS
  For each strategy the following points were addressed: the information to be given to the consultee, the procedure and the indications. In addition, the committee's opinion about BRCA1 and BRCA2 mutation screening is that population-based, or even large-scale, implementation are not justified. Although no scientific evidence is available, the committee feels that specific management is indispensable and advocates the use of defined and evaluated procedures, and participation in clinical trials.
authors.affiliation: INSERM CRI 9703, Paoli-Calmettes Institute, Marseille, France.
authors.forename: F
authors.initials: F
authors.lastname: Eisinger
authors.forename: N
authors.initials: N
authors.lastname: Alby
authors.forename: A
authors.initials: A
authors.lastname: Bremond
authors.forename: J
authors.initials: J
authors.lastname: Dauplat
authors.forename: M
authors.initials: M
authors.lastname: Espié
authors.forename: P
authors.initials: P
authors.lastname: Janiaud
authors.forename: F
authors.initials: F
authors.lastname: Kuttenn
authors.forename: J P
authors.initials: JP
authors.lastname: Lebrun
authors.forename: J P
authors.initials: JP
authors.lastname: Lefranc
authors.forename: J
authors.initials: J
authors.lastname: Pierret
authors.forename: H
authors.initials: H
authors.lastname: Sobol
authors.forename: D
authors.initials: D
authors.lastname: Stoppa-Lyonnet
authors.forename: D
authors.initials: D
authors.lastname: Thouvenin
authors.forename: H
authors.initials: H
authors.lastname: Tristant
authors.forename: J
authors.initials: J
authors.lastname: Feingold
mesh_terms: D001943:Breast Neoplasms / Q000453:epidemiology / Q000235:genetics / Q000517:prevention & control* / Q000628:therapy; D003695:Delivery of Health Care / Q000592:standards; D005260:Female; D005602:France; D005817:Genetic Counseling / Q000331:legislation & jurisprudence; D006801:Humans; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000235:genetics / Q000517:prevention & control* / Q000628:therapy; D011322:Primary Prevention / Q000592:standards