Include in the discussion the positive effects of reducing the risk of breast and ovarian cancer and the negative effects of a surgically induced menopause. The stage of a breast cancer is determined by the cancer’s characteristics, such as how large it... Tamoxifen is the oldest and most-prescribed selective estrogen receptor modulator (SERM).... Stay informed about current research, online events, and more. [2004], 1.3.8 Support mechanisms (for example, risk counselling, psychological counselling and risk management advice) need to be identified, and should be offered to women not eligible for referral and/or surveillance on the basis of age or risk level who have ongoing concerns. Advice to return to primary care to discuss any implications if there is a change in family history or breast symptoms develop. Details of any trials or studies that may be appropriate. [2004], 1.1.4 A person should be given the opportunity to discuss concerns about their family history of breast cancer if it is raised during a consultation. Create a profile for better recommendations. Removing the ovaries lowers the risk of breast cancer because the ovaries are the main source of estrogen in a premenopausal woman's body. ASCO guidelines give doctors recommendations for treatments that are supported by much credible research and experience. Certain medicines may interfere with tamoxifen's protective effects. [2013], 1.7.66 Offer people with invasive breast cancer or ductal carcinoma in situ and a 30% probability of a TP53 mutation, genetic testing to help determine their treatment options. 1.6.2 Do not routinely offer ultrasound surveillance to women at moderate or high risk of breast cancer but consider it: when MRI surveillance would normally be offered but is not suitable (for example, because of claustrophobia), when results of mammography or MRI are difficult to interpret. [2013], 1.7.63 Do not offer risk-reducing surgery to people with comorbidities that would considerably increase the risks of surgery. [2004], 1.4.10 Women attending genetic counselling should receive standardised information beforehand describing the process of genetic counselling, information to obtain prior to the counselling session, the range of topics to be covered and brief educational material about hereditary breast cancer and genetic testing. [2004], 1.1.17 Where no family history verification is possible, agreement by a multidisciplinary team should be sought before proceeding with risk-reducing surgery. [2004]. [2013]. [2004], 1.5.3 Discussion of genetic testing (predictive and mutation finding) should be undertaken by a healthcare professional with appropriate training. [2006, amended 2013], 1.6.22 For women under 50 years who are having mammography, use digital mammography at centres providing digital mammography to national breast screening programme standards. Office of the Associate Director for Science (OADS), Family Health History and the BRCA1 and BRCA2 genes, U.S. Department of Health & Human Services, Grandmother with breast cancer diagnosed at age 75, Mother with breast cancer diagnosed at age 68 and maternal aunt (mother’s sister) with breast cancer diagnosed at 62. [2004], 1.7.6 For women with BRCA1 mutations, the conflicting effects of a potential increased risk of breast cancer under the age of 40 years and the lifetime protection against ovarian cancer risk from taking the oral contraceptive pill should be discussed. [2004], 1.7.3 Healthcare professionals should be able to provide information on the effects of hormonal and reproductive factors on breast cancer risk. Prophylactic breast surgery may be able to reduce a woman's risk of developing breast cancer by as much as 97%. NCCN Guidelines Version 3.2019 Genetics/Familial High-Risk Assessment: Breast and Ovarian. [2013], 1.5.11 Offer genetic testing in specialist genetic clinics to a relative with a personal history of breast and/or ovarian cancer if that relative has a combined BRCA1 and BRCA2 mutation carrier probability of 10% or more. In some cases, a strong family history of breast cancer is linked to having an abnormal gene associated with a high risk of breast cancer, such as the BRCA1 or BRCA2 gene. [2004], 1.7.14 Alternatives to HRT should be considered for specific symptoms such as osteoporosis or menopausal symptoms (see also recommendations 1.7.53 and 1.7.54). This definition is in line with the NICE technology appraisal guidance on the primary prevention of osteoporotic fragility fractures in postmenopausal women and the World Health Organization. [2013], 1.7.58 Give all women considering a risk-reducing mastectomy the opportunity to discuss their options for breast reconstruction (immediate and delayed) with a member of a surgical team with specialist skills in oncoplastic surgery or breast reconstruction. 1, High risk of breast cancer (but with a 30% or lower probability of being a Women should all be given information in an accessible format. Recommended screening guidelines include: Your personal screening plan also may include the following tests to detect any cancer as early as possible: You may have these tests more often than a woman at average risk. Learn more about our commitment to your privacy. It's important to remember that no procedure -- not even removing both healthy breasts and ovaries at a young age -- totally eliminates the risk of cancer. The prescriber should follow relevant professional guidance, taking full responsibility for the decision. Last updated: [2017]. [2017], 1.7.22 Offer anastrozole[7][8] for 5 years to postmenopausal women at high risk of breast cancer unless they have severe osteoporosis. [2004], 1.2.2 To ensure a patient-professional partnership, patients should be offered individually tailored information, including information about sources of support (including local and national organisations). [2004], 1.2.4 Standard information should be evidence based wherever possible, and agreed at a national level if possible (NICE's information for the public provides a good starting point). [2013], 1.7.54 Manage menopausal symptoms occurring when HRT is stopped in the same way as symptoms of natural menopause. [2004], 1.7.46 Healthcare professionals should be aware that women being offered risk-reducing bilateral oophorectomy may not have been aware of their risks of ovarian cancer as well as breast cancer and should be able to discuss this. [2013], 1.5.10 Clinical genetics laboratories should record gene variants of uncertain significance and known pathogenic mutations in a searchable electronic database. For people being referred back to primary care. Visit the, Arimidex has been shown to reduce the risk of first-time, hormone-receptor-positive breast cancer in postmenopausal women at high risk. If your brother or father have been diagnosed with breast cancer, your risk is higher, though researchers aren't sure how much higher. [2013], 1.7.59 Ensure that risk-reducing mastectomy and breast reconstruction are carried out by a surgical team with specialist skills in oncoplastic surgery and breast reconstruction. BRCA 1.3.9 Support is needed for primary care health professionals to care for women with a family history of breast cancer. [2013], 1.7.62 Defer risk-reducing bilateral salpingo-oophorectomy until women have completed their family. [2004], 1.1.16 If substantial management decisions, such as risk-reducing surgery, are being considered and no mutation has been identified, clinicians should seek confirmation of breast cancer-only histories (via medical records/cancer registry/death certificates). For people being cared for in secondary care. 1.1.1 When a person with no personal history of breast cancer presents with breast symptoms or has concerns about relatives with breast cancer, a first- and second-degree family history should be taken in primary care to assess risk, because this allows appropriate classification and care. BRCA Families affected by bilateral cancer (each breast cancer has the same count value as one relative): one first-degree relative with cancer diagnosed in both breasts at younger than an average age 50 years [2004] or, one first-degree or second-degree relative diagnosed with bilateral cancer and one first or second degree relative diagnosed with breast cancer at younger than an average age of 60 years. [2013], 1.6.8 Consider annual MRI surveillance for women aged 50–69 years with a known TP53 mutation. [2013], 1.6.1 Women at increased risk of breast cancer should be 'breast aware' in line with Department of Health advice for all women. See the General Medical Council's Prescribing guidance: prescribing unlicensed medicines for further information. [2004], 1.5.7 A search/screen for a mutation in a gene (such as BRCA1, BRCA2 or TP53) should aim for as close to 100% sensitivity as possible for detecting coding alterations and the whole gene(s) should be searched.
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