3
Management
Recommendation 1.1
➤ Germline BRCA status should not preclude a patient with newly
diagnosed breast cancer otherwise eligible for breast conserving
therapy (BCT) from receiving BCT. (Moderate recommendation; FC-I)
Recommendation 1.2
➤ Surgical management of the index malignancy (BCT vs. ipsilateral
therapeutic and contralateral risk-reducing mastectomy) in BRCA1/2
mutation carriers should be discussed considering the increased
risk of contralateral breast cancer and possible increased risk of
an ipsilateral new primary breast cancer compared to non-carriers.
(Strong recommendation; FC-I)
Recommendation 1.3
➤ The following factors should be considered for assessing risk
of contralateral breast cancer (CBC) and role of risk-reducing
mastectomy in BRCA1/2 mutation carriers: age of diagnosis (the
strongest predictor of future contralateral breast cancer; family
history of breast cancer, overall prognosis from this or other cancers
(e.g., ovarian), ability of patient to undergo appropriate breast
surveillance (MRI), comorbidities, and life expectancy. (Moderate
recommendation; FC-L)
Recommendation 1.4
➤ BRCA1/2 mutation carriers who do not have bilateral mastectomy
should undergo high-risk breast screening of remaining breast tissue
with annual mammogram and MRI. (Moderate recommendation; FC-L)
Recommendation 2.1
➤ For women with newly diagnosed breast cancer who have a mutation
in a moderate-penetrance breast cancer susceptibility gene, mutation
status alone should not determine local therapy decisions for the
index tumor or contralateral risk-reducing mastectomy. (Moderate
recommendation; FC-L)
Recommendation 2.2
➤ In breast cancer patients with a mutation in a moderate-penetrance
breast cancer susceptibility gene, BCT should be offered to patients
for whom BCT is an appropriate treatment option. (Moderate
recommendation; FC-L)
Note: There is a lack of data regarding ipsilateral breast cancer events after BCT among
patients with moderate-risk mutations.
