Developments on prevention for BRCA2?
Meet the Experts
Hope S. Rugo, M.D. is a clinical professor of medicine in the division of hematology and oncology at the University of California San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, where she directs the Breast Oncology Clinical Trials Program.
Jennifer Armstrong, M.D. is a breast cancer oncologist at Paoli Hematology-Oncology Associates in Paoli, Pa., with a special interest in physicians' communication skills.
Question from Lhz: Are there any new developments in cancer prevention for women with the BRCA2 mutation?
- Answers —Hope Rugo, M.D.: There is a fair amount of work being done looking at specific pathways for women with the BRCA2 mutation. The first studies in this area will probably involve treatment as opposed to prevention. The prevention areas are really still looking at hormone therapy and in particular considering the use of aromatase inhibitors.
One study called the APRIS study is looking at postmenopausal women with no previous breast cancer history who have the BRCA mutation, studying the use of aromatase inhibitors in that population of patients. In addition, there is a body of literature that shows that ovarian suppression usually in the form of prophylactic oophorectomy (ovary removal) reduces the risk of subsequent breast cancer by 50%.
There is interest in causing ovarian suppression, then adding back a low level of hormones to avoid the side effects of early menopause in younger women. Even women with the BRCA mutation will still benefit from an oophorectomy by the age of 35 with a 50% reduction in their risk of developing breast cancer.
In terms of scanning, MRIs have been very interesting. The problem with these tests is the high incidence of false positives. However, for women with the BRCA mutation who have breasts, screening MRIs have slightly more benefit than risk. The first MRI scan is most likely to be positive, so the number of scans necessary is not at all clear. Yearly scans are likely too frequent, but that remains to be seen. The field of statins is also interesting in prevention. This is an area of interest for BRCA carriers as well. - Jennifer Armstrong, M.D.: That's a great point in that most of the preventive measures have been relative to BRCA1 and 2 carriers. To my knowledge, there have not yet been specific recommendations for carriers of one mutation as opposed to the other.
On Wednesday, June 15, 2005 our Ask-the-Expert Online Conference was called Updates from the 2005 ASCO Annual Meeting. Hope Rugo, M.D. and moderator Jennifer Armstrong, M.D. answered your questions on the latest research advances presented at the 2005 American Society of Clinical Oncology meeting in Orlando, FL.
The materials presented in these conferences do not necessarily reflect the views of breastcancer.org. A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.
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