title: Management of women with a hereditary predisposition for breast cancer.
abstract: Women with a hereditary breast cancer predisposition have three management options: screening, chemoprevention (risk-reducing medication) and risk-reducing surgery. However, no randomized trials have addressed the effect of these strategies in mutation carriers. In the general population, randomized trials failed to demonstrate a benefit for screening in premenopausal women. Moreover, although chemoprevention reduces breast cancer incidence in high-risk populations, this benefit is potentially confined to estrogen receptor-positive tumors. Finally, observational studies suggest that prophylactic mastectomy and even prophylactic salpingo-ophorectomy reduces breast cancer risk in BRCA mutation carriers, but there are systematic biases associated with such studies. Therefore, women with a hereditary predisposition for breast cancer should be informed of the three risk-reducing strategies, and that their benefits are not fully understood.
authors.affiliation: Division of Surgical Oncology & Endocrine Surgery, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Ismail
authors.initials: I
authors.lastname: Jatoi
authors.affiliation: Addenbrookes Hospital, Cambridge University, Cambridge, UK.
authors.forename: John R
authors.initials: JR
authors.lastname: Benson
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D005260:Female; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D006801:Humans; D008408:Mastectomy / Q000379:methods; D009154:Mutation; D019683:Penetrance; D011292:Premedication; D011379:Prognosis; D012307:Risk Factors
keywords: breast cancer; chemoprevention; genetic testing; hereditary predisposition; prophylactic surgery; screening