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 Printable version |
Recommendations for medical management of hereditary breast and ovarian cancer: the Inserm-FNCLCC ad hoc committee |
Bulletin du Cancer. Volume 86, Number 3, 307-13, Mars 1999, Tribune libre
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 Résumé
Article gratuit
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Author(s) : François Eisinger, Nicole Alby, Alain Bremond, Jacques Dauplat, Marc Espié, Paul Janiaud, Frédérique Kuttenn, Jean-Pierre Lebrun, Jean-Pierre Lefranc, Janine Pierret, Hagay Sobol, Dominique Stoppa-Lyonnet, Dominique Thouvenin, Henri Tristant, Josué Feingold |
Summary : Background: Almost 10% of breast and ovarian cancer are inherited, and the majority are linked to BRCA1 and BRCA2 germline mutations. Despite the uncertainty, consensus guidelines were defined to assist practitioners’, and patients’ decisions about the health care decisions to be made. Methodology: The ad hoc committee consisted of 14 experts designated by the French National Institute for Health and Medical Research. They all attended eleven workshops at which a systematic analytical review of more than 3,500 articles was carried out. Five additional experts critically analyzed the first version of the report. Process: Two thresholds were defined on a probability scale giving the risk of developing breast or ovarian cancer, to serve as a means of deciding as whether an intervention is worthwhile. The first threshold is that above which an intervention can be envisaged or recommended; the second is that under which an intervention can be ruled out; between the two, the decision has to be made on a each by case basis. Screening and preventive strategies analyzed: About breast cancer: 1) hormonal interventions; 2) primary prevention (diet, family planning and chemoprevention); 3) screening (breast self-examination, clinician breast examination, tumor markers, imaging); 4) prophylactic mastectomy. About ovarian cancer: 1) hormonal stimulation; 2) screening (clinical screening, ultrasound and tumor markers); 3) prophylactic oophorectomy. Main conclusions: With each strategy the following points were dealt with: the information to be delivered to the consultand, the procedure and the indications. The committee’s opinion about BRCA mutation screening is that population-based or even large scale implementation are not justified. The committee feels that specific management is indispensable and advocates the use of defined and evaluated procedures, and involvement in clinical trials. |
Keywords : BRCA1, BRCA2, breast cancer, guidelines, ovarian cancer, preventive care. |
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