BRCA

Question 1

what % of all breast cancers and ovarian cancers are BRCA?

Answer 1

10% of all ovarian cancers

5% of all breast cancers

Question 2

What is breast/ovarian cancer risk with BRCA 1 and BRCA 2?

Answer 2

• BRCA1: breast 45-85%, ovarian ~45%
• BRCA2: breast 45-85%, ovarian ~25%
• risk of male breast cancer 6%

Question 3

what other risks does BRCA impose?

Answer 3

• pancreatic
• prostate
• gastric
• melanoma

Question 4

what are the types of cancer most associated with BRCA ovarian cancers?

Answer 4

• serous

- endometroid

Question 5

what is surveillance for BRCA patients– for breast and ovarian cancer?

Answer 5

breast

• 25-29: 1) breast exam q6-12 month, 2) annual radiographic screening with MRI
• 30+: mammography, MRI alternating q6 months

ovarian
- reasonable to consider TVUS/CA125/pelvic exam 1-2x/year

Question 6

benefits of mastetcomy

Answer 6

• risk reducing 85-100%

- important to do bilateral bc 30% risk of contralateral breast cancer in subsequent 10 years

Question 7

when to do BSO? what are benefits

Answer 7

BRCA 1: 35-40 yrs, BRCA 2: 40-45 yrs

RR by 80%

Question 8

risk of malignancy at the time of RR BSO for BRCA?

Answer 8

2-3%

therefore get pelvic washings, do thorough peritoneal/omental inspection

Question 9

options for chemoprophylaxis for ovarian/breast cancer?

Answer 9

• OCPs: decrease ovarian cancer risk by 33-80% in BRCA 1 and 58-62% in BRCA-2
• Tamoxifen pre and post meno/Raloxifene (Evista) - postmenopausal only for BRCA 2 (50-60% risk reduction)

In general chemo ppx only to women over 35

Question 10

how much does having a first degree relative increase your risk of breast cancer?

Answer 10

2-3x

Question 11

who get’s screened/sent to genetic counseling?

Answer 11

• anyone with epithelial ovarian/PP/fallopian tube cancer
• anyone with breast cancer pretty much that ISN’T (diagnosed after age 45 + NO fmhx + receptor positivity)

no cancer:

• 1st /2nd degree relative that qualifies for testing
• male breast cancer in close relative
• relative with BRCA

Question 12

what are the categories of breast/ovarian cancer clusters?

Answer 12

• sporadic
• BRCA
• lynch syndrome
• autosomal dominant inheritance pattern of a condition not yet identified