Management of patients with BRCA1/2-associated breast cancer

Abstract

BRCA1/2-related breast cancers (BC) can be considered a separate entity compared to sporadic ones. Current knowledge suggests that the overall management is different. Herein, the different topics of management of BRCA1/2-associated BC are considered including cancer genetic counseling, surveillance, chemoprevention, prophylactic surgery, oncological treatment and psychosocial aspects. Cancer genetic counseling is a specific modality for the management of at-risk subjects that foresees a multidisciplinary approach and patientsfocused interventions. An integrated multidisciplinary approach in cancer genetic counseling (CGC) is required to support women with high inherited risk of developing hereditary cancers in the complex decisions related to cancer risk management choice. Surveillance for at-risk body sites should be integrated to the conventional oncological follow-up of BC patients and offered to the healthy family members. Chemoprevention and prophylactic surgery are viable options of cancer risk management. Particularly, prophylactic surgery can be considered an effective strategy for BRCA1/2 mutation carriers, because of a significant reduction of BC and ovarian cancer risk. Promising findings concern specific oncological treatment, including also target therapies in this setting. It is necessary that during CGC process the subject at-risk takes an active role, facilitated by a personalized approach and a focus on the patient’s emotional state. A patient-centered approach by a biopsychosocial perspective is needed for the taking charge of at-risk women.