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Risk Management for Female with a High Breast Cancer Risk (and family history of Ovarian Cancer)
This guideline discusses management for unaffected women with a strong family history of breast cancer, based on a validated risk assessment tool, and a verified family history of epithelial ovarian cancer, in the absence of a confirmed BRCA 1 or BRCA 2 mutation.
This risk management guideline has been developed for individuals who have NOT been diagnosed with a relevant cancer.
The target group includes
- women at >30% lifetime risk (or >8% risk between 40-50 years) of breast cancer using a validated risk-assessment model (e.g. BOADICEA) who also have a verified family history of invasive non-mucinous epithelial ovarian/fallopian/peritoneal cancer AND
- where genetic testing has not detected a mutation in a breast/ovarian cancer predisposition gene, or where genetic testing has not been possible
It also excludes
- families with one woman with ovarian cancer and no additional family history of breast or ovarian cancer
- individuals with a mutation in a cancer predisposition gene
- an untested blood relative if an individual with a mutation in a breast/ovarian cancer predisposition gene
| Cancer | This target group | General population up to the age of 85 yrs |
|---|---|---|
| Breast | >30% lifetime risk (or >8% decade risk between 40-50y) | 11% |
| Ovarian | Varies with family history and is not increased in all individuals | 1.1% |
Cancer Management Guidelines
Breast
Surveillance
Individualised screening may be required if there has been a breast cancer diagnosed 35 years and younger.
Recommended Screening
• starting at 40 years
• Annual mammograms (with or without ultra sounds) from 40 years
• Offer annual MRI’s from 40-49 years in addition to mammograms
Contraindications: Pregnancy but ultra sound scans can be considered
The impact of lifestyle on cancer occurrence should be discussed.
Risk Reducing Medications
Provide information of risk reducing medication. Tamoxifen and raloxifene have been found to reduce breast cancer risk in unaffected high-risk women but there are risks and benefits to this and it is not suited for everyone. Careful discussion with a medical professional is required.
Risk Reducing Surgery
Discuss bilateral risk reducing mastectomy followed by self surveillance of breast area.
Ovary
Surveillance
Do not offer Ca125 or TVS
Risk Reducing Surgery
- Individualized discussion of risk-reducing bilateral salpingo-oopherectomy
- Peritoneal lavage and careful histological examination of resection specimens are required to assess for occult cancers at RRBSO
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