Gastric & Breast Cancer
DOI: 10.2122/gbc.2004.0030

Improving 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.

From 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:
droukos@cc.uoi.gr

Abstract Introduction Data Choosing Prevention Intervetion Conclusions References A 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?