Certain groups of women who are at increased risk for carrying BRCA1 or BRCA2 genes should be assessed for the need for genetic testing, and women at increased risk for breast cancer and low risk of adverse events should be offered risk-reducing medications, the U.S. Preventive Services Task Force (USPSTF) recommended.
In August and September 2019, USPSTF released updates to its recommendations for BRCA-related cancer prevention and medications to reduce breast cancer risk, respectively. The organization maintained its B recommendation (recommended) that suspected high-risk women who have a family history of certain cancers or an ancestry associated with BRCA1 or BRCA2 mutations should be:
- Assessed for risk
- Offered genetic counseling
- If indicated after counseling, offered BRCA testing
Previously, USPSTF recommended this for women with a family history of breast, ovarian, fallopian tube, or peritoneal cancers. The new recommendation adds to that women with a personal history of those cancers and women with ancestry associated with the mutations (e.g., Ashkenazi Jews). USPSTF gave a D recommendation (not recommended) for testing in women who do not meet those criteria.
The second recommended statement addressed use of risk-reducing medications (e.g., tamoxifen, raloxifene, aromatase inhibitors) to prevent breast cancer. USPSTF gave a B recommendation to use the medications in women aged 35 years and older without signs or symptoms of breast cancer who are at increased risk for cancer but low risk for adverse medication effects. But because the panel found that the medications are associated with small to moderate harms, the organization gave a D recommendation for use in women who are not at increased risk for breast cancer.