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Clinical Crossroads
Clinician's Corner
June 1, 2011

Management of Women With BRCA Mutations A 41-Year-Old Woman With a BRCA Mutation and a Recent History of Breast Cancer

Author Affiliations

Author Affiliations: Dr Tung is Director, Cancer Risk and Prevention Program, Beth Israel Deaconess Medical Center, and Assistant Professor of Medicine, Harvard Medical School.

JAMA. 2011;305(21):2211-2220. doi:10.1001/jama.2011.678
Abstract

Ms E, a 41-year-old BRCA1 mutation carrier, was diagnosed 4 years ago as having breast cancer and opted for breast-conserving therapy. Prior to receiving chemotherapy, she harvested her eggs through in vitro fertilization and subsequently used preimplantation genetic diagnosis; 3 months ago she delivered a healthy boy. This review examines the prevalence of BRCA mutations in women with breast cancer, as well as current recommendations for surgery and systemic therapy in these women. In particular, the risk of a contralateral breast cancer is reviewed to help guide the choice of prophylactic mastectomies vs breast-conserving therapy. The technology of preimplantation genetic diagnosis and genetic testing in relatives of mutation carriers is discussed.

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