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An international survey of surveillance schemes for unaffected BRCA1 and BRCA2 mutation carriers
유방암 연구 저널 An international survey of surveillance schemes for unaffected BRCA1 and BRCA2 mutation carriers 2016.04.27.
Breast Cancer Research and Treatment 157, pages319–327 (2016) 논문 보기
Purpose
Female BRCA1/BRCA2 mutation carriers are at substantially increased risk for developing breast and/or ovarian cancer, and are offered enhanced surveillance including screening from a young age and risk-reducing surgery (RRS)-mastectomy (RRM) and/or salpingo-oophorectomy (RRSO). While there are established guidelines for early detection of breast cancer in high-risk women who have not undergone RRM, there are less developed guidelines after RRM. We evaluated the schemes offered before and after RRS in internationally diverse high-risk clinics.

Methods
An e mailed survey distributed to high-risk clinics affiliated with CIMBA.

Results
Overall, 22 centers from 16 countries responded. Pre RRS surveillance schemes overwhelmingly included breast imaging (primarily MRI) from 18–30 years and clinical breast exam (CBE) at 6–12 month intervals. For ovarian cancer, all but 6 centers offered semiannual/annual gynecological exam, transvaginal ultrasound, and CA 125 measurements. Post RRM, most centers offered only annual CBE while 4 centers offered annual MRI, primarily for substantial residual breast tissue. After RRSO only 4 centers offered specific gynecological surveillance.

Conclusions
Existing guidelines for breast/ovarian cancer detection in BRCA carriers are being applied pre RRS but are not globally harmonized, and most centers offer no specific surveillance post RRS. From this comprehensive multinational study it is clear that evidence-based, long term prospective data on the most effective scheme for BRCA carriers post RRS is urgently needed

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