4th Annual Joining FORCES Against Hereditary Caner
Conference on Hereditary Breast & Ovarian Cancer 2009
What’s New for BRCA +/Hereditary BC Survivors
- BRCA1 typically triple -, poorly differentiated, high grade, ck 5/6, ck14+, EGFR+, cyclin E+, little DCIS, basal like
- BRCA1 did just as well with nonBRCA with chemo
- BRCA1 85% protected w/oopherectomy; BRCA2 50%
- Those with oopherectomy should still get CA125 once a year
Risk Reducing Salpingo-Oophorectomy
- Fallopian tube and ovary should be removed to combat disease by 80-90% & 50-60% reduction in breast cancer
- Open surgery with traditional laparotomy is 2-4 day hospital stay, 4-6 weeks recovery; Minimally invasive surgery with conventional laparoscopic or robotic assist is outpatient with 2 week recovery
- Thorough inspection of peritoneal surfaces with saline “wash” to get samples; staging can be done at this time
- Robotic da Vinic less pain, faster recovery, improved surgical vision, dexterity and ergonomics (better for longer more complex surgeries; basic laprascopic best for oophorectomy only)
- Most gynecological oncologist should be qualified but it takes a team effort, 20-20 operations is considered experienced
Inconclusive BRCA Test Results
- Tested w/normal results but w/cancer- 1.) BRCA is 95% accurate & Myriad will run BART testing if you have over 30% family risk; most insurance will NOT cover BART. 2.) Another Gene HNPCC (ovarian) or PTEN (breast) or an unknown gene. 3.) Could not be genetic but combination of genes and environment
- Cancer free person w/normal results- 1.) Test missed mutation 5% chance. 2.) Another gene involved. 3.) Could not be genetic. 4.) Could be BRCA in family but 50% chance
- Variants-1. Suspectous deleterious, 2. Suspected polymorphism (fairly harmless,) 3. Variant of uncertain significance
- Look at family history, genetic tendency but can be environmental too, SNIP test to decode and insurance should pay for it
Breast Cancer Prevention: Nonsurgical Approach to Risk Reduction
- Intraductal access nipple lavage
- AI, nanoparticle Herceptin, gene therapy and parp inhibitor though need to determine dose and long term study
- Delay menarche with physical activity and as a life long activity
- Reduce inflammation
- Tamoxifen
Management of Ovarian Cancer Risk
- CA125 is elevated in only 50% of stage 1 cancer; better for recurrence following, false positives common; have more done to define correct number for self; 35 is normal
- Transvanginal US can lead to more unnecessary surgery but also accounted for most early stage dx
- HE4 released in Europe and good for those with large mass and to use in conjunction with CA125; waiting for FDA approval though likely to be approved this year in US
- First 10 days of period to have transvaginal US has less false positive
- Chemoprevention: oral contraceptives (pill seems to be better vs patch), Fanretinide, Vitamin D3, Aspirin, motrin, etc
- Begin ovarian screening between 30 and 35; screening every 6 months; oophorectomy between 35 and 40
Blood test P53 if less than 35 with breast cancer and test negative for BRCA may ask for this test
http://www.lbl.gov/Education/ELSI/Frames/cancer-genes-f.html
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