GO TO CMA Home
GO TO Inside CMA
GO TO Advocacy and Communications
GO TO Member Services
GO TO Publications
GO TO Professional Development
GO TO Clinical Resources

GO TO What's New
GO TO Contact CMA
GO TO Web Site Search
GO TO Web Site Map


CMAJ
CMAJ - June 2, 1998JAMC - le 2 juin 1998

More on breast cancer guidelines

CMAJ 1998;158:1429

See response from: M. McGregor
We were pleased to see the publication of this supplement. However, we were disappointed that although the guideline "The palpable breast lump: information and recommendations to assist decision-making when a breast lump is detected" (CMAJ 1998;158[3 Suppl]:S3-8 [full text / text complet]) mentioned strong family history among the factors that increase the likelihood of breast cancer (level III evidence), nowhere else in the document was there any discussion of the recently discovered breast cancer susceptibility genes. It is now known that mutations in 2 recently identified genes, BRCA1 and BRCA2, confer a risk of breast cancer. Mutations in these genes appear to account for 5% to 10% of all cases of breast cancer. Identification of such mutations provides important information about the risk of additional neoplasms in the affected individual and other family members. This risk includes the association of breast cancer with ovarian cancer in predisposed families and the risk of breast cancer among male members of these families. Furthermore, in some families with familial breast and ovarian cancer, there could be increased predisposition to colerectal cancer.1

The guidelines document also indicates that the risk of breast cancer increases with age. In 1997 in Canada the cumulative risk of breast cancer was approximately 11% by age 70 years.2 This risk is much higher in families known to carry one of the mutant alleles. The cumulative risk for women carrying BRCA1 mutations may be as high as 85% by age 70 years.3

The Cancer Genetics Studies Con-sortium recently published its recommendations for follow-up care of people with an inherited predisposition to breast cancer because of mutant genes.4 The consortium concluded that identifying people with the relevant mutations is a necessary first step in improving prevention and treatment. Early breast and ovarian cancer screening was recommended for people with BRCA1 mutations and early breast cancer screening for those with BRCA2 mutations.

The management of breast cancer should surely include its prevention among high-risk individuals. We suggest that the steering committee seek the advice and involvement of the genetic community for the next version of these guidelines.

Bassam A. Nassar, PhD, MB, BCh
Mark D. Ludman, MD
M. Teresa Costa, MD
J. Philip Welch, MB, ChB, PhD
Charles A. Butts, MD
Jonathan R. Love, MD
Heather Hogg, BSc, RN
M. Jill Beis, MSc
Co-participants
The Maritime Hereditary Cancer
Programme
Dalhousie University
Halifax, NS

References

  1. Ford D, Easton DF. The genetics of breast and ovarian cancer. Br J Cancer 1995;72:805-12.
  2. Canadian cancer statistics 1997. Toronto: National Cancer Institute of Canada; 1997.
  3. Easton DF, Ford D, Bishop DT, Breast Cancer Linkage Consortim. Breast and ovarian incidence in BRCA1-mutation carriers. Am J Hum Genet 1995;56:265-71.
  4. Burke W, Daly M, Garber J, Botkin J, Kahn MJE, Lynch PL, et al, for the Cancer Genetics Studies Consortium. Recommendations for follow-up care of individuals with an inherited predispositon to cancer. II. BRCA1 and BRCA2. JAMA 1997;277:997-1003.

Comments Send a letter to the editor
Envoyez une lettre à la rédaction