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

Manageme...

...tion 1.1Germline BRCA status should no...


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


...commendation 1.3The following factors shoul...


...1.4BRCA1/2 mutation carriers who do not have...


...mmendation 2.1For women with newly diagnos...


...commendation 2.2In breast cancer patients with...


...on 2.3The evidence regarding contralateral breast...


...ecommendation 2.4Patients with mutations i...


...ommendation 3.1For women with newly diagnosed brea...


...commendation 3.2For women with newly diagnosed...


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


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


...n 5.1For breast cancer patients with a...


Recommendation 5.2For breast cancer...


Recommendation 6.1For women with breast can...


Recommendation 6.2For women with breast can...


...dation 6.3For women with breast cancer...


...on 7When offering chemotherapy for ger...


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


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


...ndation 9.2For breast cancer patients...


...mendation 10 – ASCO Recommendation Update...


...e 1. Management of Hereditary Breast...

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

...herapy Recommendations...

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...herapy Recommendations...

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...Second Cancer For women with breast ca...

...herapy Recommendations

...cancer patients with mutations in mo...


...2. Clinical Stage + Pathologic Stage + ER sta...