Risk Assessment, Genetic Counseling, and Genetic Testing for BRCA-Related Cancer: US Preventive Services Task Force Recommendation Statement.

US Preventive Services Task Force, Owens DK1,2, Davidson KW3, Krist AH4,5, Barry MJ6, Cabana M7, Caughey AB8, Doubeni CA9, Epling JW Jr10, Kubik M11, Landefeld CS12, Mangione CM13, Pbert L14, Silverstein M15, Simon MA16, Tseng CW17,18, Wong JB19.

Author information

1: Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
2: Stanford University, Stanford, California.
3: Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York.
4: Fairfax Family Practice Residency, Fairfax, Virginia.
5: Virginia Commonwealth University, Richmond.
6: Harvard Medical School, Boston, Massachusetts.
7: University of California, San Francisco.
8: Oregon Health & Science University, Portland.
9: Mayo Clinic, Rochester, New York.
10: Virginia Tech Carilion School of Medicine, Roanoke.
11: Temple University, Philadelphia, Pennsylvania.
12: University of Alabama at Birmingham.
13: University of California, Los Angeles.
14: University of Massachusetts Medical School, Worcester.
15: Boston University, Boston, Massachusetts.
16: Northwestern University, Evanston, Illinois.
17: University of Hawaii, Honolulu.
18: Pacific Health Research and Education Institute, Honolulu, Hawaii.
19: Tufts University School of Medicine, Boston, Massachusetts.

Abstract

IMPORTANCE:

Potentially harmful mutations of the breast cancer susceptibility 1 and 2 genes (BRCA1/2) are associated with increased risk for breast, ovarian, fallopian tube, and peritoneal cancer. For women in the United States, breast cancer is the most common cancer after nonmelanoma skin cancer and the second leading cause of cancer death. In the general population, BRCA1/2 mutations occur in an estimated 1 in 300 to 500 women and account for 5% to 10% of breast cancer cases and 15% of ovarian cancer cases.

OBJECTIVE:

To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer.

EVIDENCE REVIEW:

The USPSTF reviewed the evidence on risk assessment, genetic counseling, and genetic testing for potentially harmful BRCA1/2 mutations in asymptomatic women who have never been diagnosed with BRCA-related cancer, as well as those with a previous diagnosis of breast, ovarian, tubal, or peritoneal cancer who have completed treatment and are considered cancer free. In addition, the USPSTF reviewed interventions to reduce the risk for breast, ovarian, tubal, or peritoneal cancer in women with potentially harmful BRCA1/2 mutations, including intensive cancer screening, medications, and risk-reducing surgery.

FINDINGS:

For women whose family or personal history is associated with an increased risk for harmful mutations in the BRCA1/2 genes, or who have an ancestry associated with BRCA1/2 gene mutations, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are moderate. For women whose personal or family history or ancestry is not associated with an increased risk for harmful mutations in the BRCA1/2 genes, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are small to none. Regardless of family or personal history, the USPSTF found adequate evidence that the overall harms of risk assessment, genetic counseling, genetic testing, and interventions are small to moderate.

CONCLUSIONS AND RECOMMENDATION:

The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with BRCA1/2 gene mutations with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing. (B recommendation) The USPSTF recommends against routine risk assessment, genetic counseling, or genetic testing for women whose personal or family history or ancestry is not associated with potentially harmful BRCA1/2 gene mutations. (D recommendation).