Management of Hereditary Breast Cancer

Publication Date: August 3, 2021

Key Points

Key Points

  • The integration of genomics into the care of oncology patients has led to an increasing population of breast cancer patients identified with germline (i.e., inherited) mutations in breast cancer susceptibility genes, requiring physicians to integrate this information into treatment decision-making.
  • Pathogenic or likely pathogenic variants (commonly referred to as mutations) in high-penetrance breast cancer susceptibility genes increase the risk of breast cancer more than 4-fold.
    • Germline mutations in BRCA1 or BRCA2 (BRCA1/2) are found in 3–4% of all women with breast cancer, including 10–20% of those with triple negative breast cancer and 10–15% of Jewish women with breast cancer.
    • The lifetime risk of breast cancer for a BRCA mutation carrier varies from 50–90% based on populations studied, gene, study design and method of analysis.
    • Other high-penetrance breast cancer susceptibility genes include PTEN (Cowden's Syndrome), TP53 (Li-Fraumeni Syndrome), STK11 (Peutz-Jeghers Syndrome), and CDH1 (Hereditary Invasive Lobular Breast-Diffuse Gastric Cancer).
    • Mutations in more moderate-penetrance genes such as PALB2, CHEK2, and ATM occur in 4–6% of breast cancer patients with lifetime risk of 35%–60% (PALB2) and 25%–30% (ATM and CHEK2).
  • Providers caring for breast cancer patients with germline BRCA1/2 mutations should discuss treatment options related to the index cancer and the increased risk of contralateral breast and new ipsilateral breast cancer.

Management

Managem...

...ion 1.1Germline BRCA status should not prec...


...mendation 1.2Surgical management of the ind...


...dation 1.3The following factors should...


...ndation 1.4BRCA1/2 mutation carriers...


...commendation 2.1For women with newly di...


...mendation 2.2In breast cancer patients with a...


...ecommendation 2.3The evidence regard...


Recommendation 2.4Patients with mutatio...


....1For women with newly diagnosed breast ca...


....2For women with newly diagnosed breast c...


...on 4.1For women with breast cancer who...


...4.2For women with breast cancer who have...


...on 5.1For breast cancer patients with a deleter...


...endation 5.2For breast cancer patient...


...6.1For women with breast cancer who ar...


...mendation 6.2For women with breast...


...on 6.3For women with breast cancer who ar...


...ion 7When offering chemotherapy for...


...8For germline BRCA mutation carriers...


...9.1For BRCA1/2 mutation carriers with...


...mendation 9.2For breast cancer patients wi...


...ation 10 – ASCO Recommendation Update...


...agement of Hereditary Breast Cancer in...

...with Breast Cancer Who Have a BRCA...

...Therapy Recommendations...

...rrent Cancer Germline BRCA status...

...Second cancer The following factors sho...

...Therapy Recommendation...

...fering chemotherapy for germline BRCA mutatio...

...n with Breast Cancer Who Have a Mu...

Local Therapy Recommenda...

...t Cancer For women with newly diagnosed...

...ion/Second Cancer For women with...

...mic Therapy Recommendati...

...breast cancer patients with mutati...


...Clinical Stage + Pathologic Stage + ER...