BRCA1/2 mutation positive, doesnt want surgery

[DrMetal]

Have you guys ever had a patient in their 40s, rich family history of breast and ovarian cancer, tested positive for the mutation, but does not want any prophylactic surgery. How would you proceed with surveillance? Obviously routine mammography is needed. Would this be an indication for routine pelvic ultrasound (q 1 year)? I read somewhere that sometimes CA 125 is checked as well? (Though i thought tumor markers were more relevant in post diagnosis and prognostic situations)

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[VA Hopeful Dr]

Have you guys ever had a patient in their 40s, rich family history of breast and ovarian cancer, tested positive for the mutation, but does not want any prophylactic surgery. How would you proceed with surveillance? Obviously routine mammography is needed. Would this be an indication for routine pelvic ultrasound (q 1 year)? I read somewhere that sometimes CA 125 is checked as well? (Though i thought tumor markers were more relevant in post diagnosis and prognostic situations)

I punt these people to our breast surgeons and OBs to manage each of those as it's tricky, and wrangling with insurance on these folks is a big pain.

The one patient I have with that gets a yearly mammogram and a yearly breast MRI offset by 6 months from the mammogram.

 

[chessknt]

Is the patient going to be ok with oopherectomy with any ultrasound finding? If you do an annual pelvic ultrasound youll probably run in to a cyst vs mass eventually and the ovary will need to come out I imagine. Sounds like a hard convo to have so once referral might be better we if they'll see her without a diagnosis

 

[DrMetal]

I punt these people to our breast surgeons and OBs to manage each of those as it's tricky, and wrangling with insurance on these folks is a big pain.

The one patient I have with that gets a yearly mammogram and a yearly breast MRI offset by 6 months from the mammogram.

yeah, i want to do the same. It's better for her to hear the risk/benefits discussion from a breast/oncology surgeon.

 

[DrMetal]

Is the patient going to be ok with oopherectomy with any ultrasound finding?

I think so. She really doesn't want any kind of surgery. No real guidelines on this, as far as I can tell.

 

[gutonc]

Have you guys ever had a patient in their 40s, rich family history of breast and ovarian cancer, tested positive for the mutation, but does not want any prophylactic surgery. How would you proceed with surveillance? Obviously routine mammography is needed. Would this be an indication for routine pelvic ultrasound (q 1 year)? I read somewhere that sometimes CA 125 is checked as well? (Though i thought tumor markers were more relevant in post diagnosis and prognostic situations)

She needs to be followed by Breast Surgery and Gyn Onc, or at least a "High-risk Clinic" if such a thing is available in your area/system.

For the women who get dxd w/ breast cancer and have a BRCA1/2 mutation, I will quarterback their other surveillance, but I always bring Gyn Onc (and GI if BRCA2) on board.

 

[DrMetal]

She needs to be followed by Breast Surgery and Gyn Onc, or at least a "High-risk Clinic" if such a thing is available in your area/system.

For the women who get dxd w/ breast cancer and have a BRCA1/2 mutation, I will quarterback their other surveillance, but I always bring Gyn Onc (and GI if BRCA2) on board.

Do you check tumor markers? I saw something in pubmed that some check a CA-125, yearly maybe. I never thought to do that (as a means of pre-diagnosis surveillance).

 

[gutonc]

Do you check tumor markers? I saw something in pubmed that some check a CA-125, yearly maybe. I never thought to do that (as a means of pre-diagnosis surveillance).

In conjunction with semi/annual pelvic US, yes, it can be done. But then, I don't do the pelvic US, so I don't check the CA125 either. That's what Gyn Onc is for.