Cancer Treatment Today » Inherited Breast Cancer http://cancertreatmenttoday.org Knowledge is Power Thu, 26 Mar 2026 23:39:25 +0000 en-US hourly 1 BREVAgen http://cancertreatmenttoday.org/brevagen/ http://cancertreatmenttoday.org/brevagen/#comments Fri, 03 Jan 2014 14:39:58 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=11773 Personalized medicine is an up and coming approach, by which individual’s risks and factors are taken into account to prescribe therapy. Genetic tests are a part of the approach. BREVAGen evaluates 7 breast cancer-associated factors. Risk is calculated by multiplying the product of the individual risks by the Gail model risk The Gail model is the first of several proposed ways to calcucalte an individual’s riask for breast cancer.  BREVAGen has been evaluated for use in Caucasian women of European descent age 35 years and older. According to the BREVAGen website, “suitable candidates” for testing include women with a Gail lifetime risk of 15% or greater; with high lifetime estrogen exposure (e.g., early menarche and late menopause); or with relatives diagnosed with breast cancer. BREVAGen is not suitable for women with previous diagnoses of lobular carcinoma in situ, ductal carcinoma in situ, or breast cancer, since the Gail model cannot calculate breast cancer risk accurately for such women, or for women with an extensive family history of breast and ovarian cancer.

BREVAgen was validated only in comparison to Gail score. Being that the Gail score is the least sensitive scoring tool available and that it is widely considered inadequate, it is hard to have confidence in the validation process. In addition, the risk calculation that depends on multiplying SNP risks by Gail raises its own questions of accuracy. Finally, there is no prospective evidence that BREVAgen produces clinical evidence.

]]> http://cancertreatmenttoday.org/brevagen/feed/ 0 Prophylactic Mastectomy in Carriers of BRCA Mutation http://cancertreatmenttoday.org/prophylactic-mastectomy-in-carriers-of-brca-mutation-2/ http://cancertreatmenttoday.org/prophylactic-mastectomy-in-carriers-of-brca-mutation-2/#comments Mon, 20 Aug 2012 18:31:06 +0000 M Levin, MD http://cancertreatmenttoday.org/?p=4698 Prophylactic total or simple mastectomy for patients at high risk of breast cancer is a difficult issue in that it involves the determination of risk in an individual patient, a separate determination of what level of risk is high enough to justify the extreme choice of prophylactic mastectomy, and assurance from scientific studies in the medical literature that this procedure does result in a reduction of breast cancer occurrence. Mastectomies that do not remove all possible breast tissue, for example subcutaneous mastectomy or simple mastectomy may leave behind enough breast tissue to sufficiently reduce the risk of breast cancer in BRCA positive women. Often the tail of the breast that goes into the armpit and contains 5% of all breast tissue may be left behind. It is, however, generally assumed that the high risks of breast cancer in women with BRCA positivity justifies mastectomy and other risk reduction measures. Even the usually parsimonious European EMO guideline of 2011 says: “It is the most effective strategy available for risk reduction of breast cancer in mutation carriers [III, B], although no benefit in survival has been demonstrated and many women do not find this strategy acceptable for cosmetic reasons. Contralateral prophylactic mastectomy is an option to consider in those BRCA mutation carriers with early breast cancer undergoing unilateral mastectomy [III, B].” Other guidelines echo these recommendations. Other options for risk reduction include hormonal prophylaxis with tamoxifen or aromatase inhibitors and/or oophorectomy as well as intensive surveillance.

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