Table 1.

Cancer risk reduction guidelines for female BRCA1 and BRCA2 mutation carriers without a personal history of breast cancer.

InterventionNCCNNICEESMOACOGeviQ
Lifestyle modificationaNot mentionedRecommendedRecommendedNot mentionedDiscuss
ChemopreventionPremenopausal - consider TamPremenopausal - consider TamConsider TamConsider Tam, especially for BRCA2Premenopausal - consider Tam
Postmenopausal – consider Tam, raloxifene or AIPostmenopausal – consider Tam or AIPostmenopausal - consider Tam, raloxifene or AI
Risk-reducing mastectomyDiscussion regarding degree of protectionDiscussion regarding degree of protection, and potential psychosocial impactDiscuss benefits, limitations, potential complications, and psychosocial impactDiscussOffer; greatest benefit ≤40 y
Risk-reducing salpingo-oophorectomy to reduce tubo-ovarian cancer riskConsider following completion of family, typically between 35 and 40 y for BRCA1 or 40–45 y for BRCA2, unless age at diagnosis in the family warrants earlier considerationDiscuss risks and benefits, including discussion of negative impact of surgically induced menopause; consider after completion of familyDiscuss, taking into account mutation type, patient preferences and family history to determine appropriate age; recommended between ages 35–40 yDiscuss between the ages of 35–40 y and after completion of childbearingRecommend from 35 y for BRCA1 and from 40 y for BRCA2; after family completion
Risk-reducing salpingo-oophorectomy to reduce BC riskDiscuss degree of risk reduction for BC; consider after completion of familyDiscuss risks and benefits, including discussion of negative impact of surgically induced menopause; consider after completion of familyNot recommended for reduction of BC riskDiscuss premenopausal rrBSO to reduce risk of BCNot recommended for reduction of BC risk
  • Note: All guidelines also recommend intensified breast cancer screening.

  • Abbreviations: AI, aromatase inhibitor; BC, breast cancer; Tam, tamoxifen; y, years.

  • aLifestyle modification including maintenance of healthy weight, participation in regular moderate-intensity exercise, minimization of alcohol intake and exogenous estrogen/progesterone exposure.