U PREVENTIVE SERVICES TASK FORCE ...

U PREVENTIVE SERVICES TASK FORCE

This statement summarizes the U Preventive Services Task Force (USPSTF) recommendations forward genetic risk assessment and BRCA mutation testing for breast and ovarian cancer susceptibility and the supporting scientific evidence. Explanations of the ratings and of the impregnability of overall evidence are given in Tables 1 and 2 respectively. The Research Gaps and Recommendations of Other arranges sections that are usually included in USPSTF recommendation statements are available in the consummate recommendation statement on the USPSTF Web site at http://www.ahrq.gov/clinic/uspstf05/ brcagen/brcagenrs.htm. The unimpaired information on which this statement is based, including evidence tables and relations is included in the systematic evidence review for the USPSTF (1) and in the evidence synthesis (2) forward this topic, available on the USPSTF Web site at http://www.preventiveservices.ahrq. gov The recommendation also is positioned on the Web site of the National Guideline Clearinghouse at http://www.guideline.gov.

Summary of Recommendations

The USPSTF commends against routine referral for genetic counseling or routine breast cancer susceptibility gene (BRCA) testing for women whose family history is not associated with an increased risk for deleterious mutations in breast cancer susceptibility gene 1 (BRCA1) or breast cancer susceptibility gene 2 (BRCA2). D recommendation.

The USPSTF plant fair evidence that women without certain specific family history patterns, space of timeed here "increased-risk family history" (see Clinical Considerations for a definition), have a grave risk for developing breast or ovarian cancer associated with BRCA1 or BRCA2 mutations. Thus, any benefit of routine screening of these women for BRCA1 or BRCA2 mutations, or routine referral for genetic counseling, would be small or naught The USPSTF found fair evidence regarding important adverse ethical, legal, and social inferences that could result from routine referral and testing of these women Interventions as it is as prophylactic surgery, chemoprevention, or intensive screening have known harms. The USPSTF estimated that the magnitude of these potential harms is small or greater.

The USPSTF conclud that the potential harms of routine referral for genetic counseling or BRCA testing in these women outweigh the benefits.

The USPSTF commends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 gene be referr for genetic counseling and evaluation for BRCA testing. B recommendation.

The USPSTF lay the foundation of fair evidence that women with certain specific family history patterns ("increased-risk family history") have an increased risk for developing breast or ovarian cancer associated with BRCA1 or BRCA2 mutations. The USPSTF determined that these women would benefit from genetic counseling that allows informed decision-making about testing and further prophylactic treatment. This counseling should be done from suitably trained health care professionals. There is insufficient evidence to determine the benefits of chemoprevention or intensive screening in improving health results in these women if they touchstone positive for deleterious BRCA1 or BRCA2 mutations. However, there is fair evidence that prophylactic surgery for these women significantly decreases breast and ovarian cancer incidence. Thus, the potential benefits of referral and discussion of testing and prophylactic treatment for these women may be substantial.

The USPSTF also originate insufficient evidence regarding important adverse ethical, legal, and social consecutions that could result from referral and testing of high-risk women Prophylactic surgery is associated with known harms. The USPSTF estimated that the magnitude of these potential harms is small.

The USPSTF conclud that the benefits of referring women with an increased-risk family history to suitably trained health care professionals outweigh the harms.

Clinical Considerations

* These recommendations apply to women who have not received a diagnosis of breast or ovarian cancer. They do not apply to women with a family history of breast or ovarian cancer that includes a relative with a known deleterious mutation in BRCA1 or BRCA2 genes; these women should be referr for genetic counseling. These recommendations do not apply to men

* Although there publicly are no standardized referral criteria, women with an increased-risk family history should be considered for genetic counseling to further evaluate their potential risks.

* Certain specific family history patterns are associated with an increased risk for deleterious mutations in the BRCA1 or BRCA2 gene the two maternal and paternal family histories are important. For non-Ashkenazi Jewish women these patterns include pair first-degree relatives with breast cancer, single of whom was diagnosed at 50 years or younger; a combination of three or more first- or second-degree relatives with breast cancer, regardless of age of diagnosis; a combination of breast and ovarian cancer among first- and second- step relatives; a first-degree relative with bilateral breast cancer; a combination of brace or more first- or second-degree relatives with ovarian cancer, regardless of age of diagnosis; a first- or second-degree relative with breast and ovarian cancer, at any age; and a history of breast cancer in a male relative.