Indications for BRCA testing

Question 1

A 42-year-old woman, gravida 2, para 2, in whom breast cancer was diagnosed at age 38 years, comes to your office for her annual well-woman visit. Her family history is significant for a mother who was diagnosed with ovarian cancer at age 68 years and a maternal aunt who developed a low- malignant-potential tumor of the ovary in her 20s. Her risk of having an inherited predisposition for ovarian cancer or breast cancer is

(A) less than 1%
(B) 1–10%
(C) 11–20%
(D) greater than 20%

Answer 1

(D) greater than 20%

Question 2

What is the lifetime risk of cancers for carriers of BRCA1/2?

Answer 2

Breast: 65-74%

Ovarian: 39-46% BRCA1, 12-20% BRCA2

Question 3

How can you reduce the risk of breast cancer or ovarian cancer in BRCA carriers?

Answer 3

Risk reducing salpingo-oophorectomy: decreases breast cancer by 50% and ovarian by 80-95%

OCPs: after 5 years, risk of ovarian cancer drops 33-38%, data still unclear on breast cancer