Gastric & Breast Cancer
Decision for Cancer Prevention of Women with BRCA Mutations
Niki J. Agnantis, MD, PhD, Evangelos Paraskevaidis,
MD,Evangelos Briasoulis,MD, Ioannis Arambatzis, MD,
and Dimitrios Roukos, MD.
the Departments of Pathology (NJA), Gynecology & Obstetrics
(EP),Medical Oncology (EB) and Surgery (DHR), at the Ioannina
University School of Medicine, GR -45110, Ioannina, Greece.
Correspondence to: Dimitrios H. Roukos, MD, Ioannina University
School of Medicine, GR -45110, Ioannina, Greece, or email:
decade after the discovery of BRCA1 and BRCA2
genes, enormous research advances have been made.
A high breast, ovarian cancer risk has been established
pressing for a prevention decision. But as surgical
and nonsurgical options abound, increases parallel
the uncertainty about a right choice.
On one hand, prophylactic surgery -bilateral mastectomy
(BM), bilateral salpingo-oophorectomy (BSO) and
resection of both breasts and ovaries, dramatically
reduces cancer risk at the organ(s) targeted by
the BRCA mutated genes but at the cost of all
disadvantages of a surgical approach. On the other,
surveillance strategies providing an excellent
quality of life (QoL) represent women's preferences.
Lifelong preservation -due incomplete penetrance
or modifying the genetic risk (tamoxifen)- or
surgical resection only when early-stage cancer
becomes clinically evident, is an ideal goal.
But is research sufficient for integration into
clinical practice without risks?
Wide variation in risk estimates, diverse impacts
of surgical and nonsurgical preventive measures
on survival and QoL, as well as lacking of randomized
controlled trial, make a right decision too complicated
and extremely challenging. As new data have become
available, what is the preventive intervention
that provides the best risk-benefit ratio in clinical
practice regarding risk reduction, survival and
quality of life?