Current policies for surveillance and management in women at risk of breast and ovarian cancer: A survey among 16 European family cancer clinics

The recent isolation of breast cancer predisposing genes (BRCA1 and BRCA2) allows the identification of carriers within affected families. These carri ers have a 50-85% risk of developing breast or ovarian cancer and need care ful follow-up. The purpose of this study was to evaluate the management and screening protocols implemented in high risk families at various family ca ncer clinics in Europe, A questionnaire was mailed to the members of the Eu ropean Familial Breast Cancer Collaborative Group (n = 30) requesting infor mation on the following issues: indication for surveillance of breasts and ovaries, the recommended protocol, coordination of the screening examinatio n, prophylactic surgery, the specific management: of breast cancer in a mut ation carrier and the use of oestrogen. 16 centres fi om nine countries res ponded, Most centres recommend surveillance of the breasts if the lifetime risk exceeds 15-20%. The surveillance protocol that is generally advised co mprises monthly self breast examination, examination by a specialist every 6 months and annual mammography, all starting from an age between 25 and 35 years. Surveillance of the ovaries is recommended in BRCA1 and BRCA2-mutat ion carriers, in members from breast/ovarian cancer families and in some ce ntres in 'breast cancer only' families with an early onset of breast cancer . The recommended protocol includes gynaecological examination, sonography and estimation of CA-125 at yearly intervals starting from the age 30-35 ye ars. Prophylactic mastectomy is considered for proven mutation carriers in some centres. Most centres consider prophylactic oophorectomy in mutation c arriers and some centres also consider it for members of breast/ovarian can cer families. This survey provides insight into the guidelines for surveill ance and management of familial breast cancer used at various family cancer clinics in Europe; this insight may contribute to the appropriate manageme nt of these high risk women. It should be emphasised that most recommendati ons are based an experts' opinion rather than on any specific studies. (C) 1998 Elsevier Science Ltd. All rights reserved.