4
Management
Recommendation 2.3
➤ The evidence regarding contralateral breast cancer risk is limited for
mutations in moderate-penetrance breast cancer genes, aside from
some data for CHEK2 1100delC. (Moderate recommendation; FC-L)
Note: Information about the specific gene and what is known about the risk of
contralateral breast cancer should be discussed in the context of shared decision-making.
Recommendation 2.4
➤ Patients with mutations in moderate-penetrance genes 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 3.1
➤ For women with newly diagnosed breast cancer undergoing
mastectomy who have a deleterious mutation in BRCA 1 or 2, nipple-
sparing mastectomy is a reasonable oncologic approach to consider
in appropriately selected patients. (Moderate recommendation; FC-I)
Recommendation 3.2
➤ For women with newly diagnosed breast cancer undergoing
mastectomy who have a deleterious mutation in moderate-penetrance
genes, nipple-sparing mastectomy is a reasonable oncologic
approach to consider in appropriately selected patients. (Moderate
recommendation; FC-L)
Recommendation 4.1
➤ For women with breast cancer who have a BRCA1/2 mutation
and who have been treated or are being treated with unilateral
mastectomy, contralateral risk-reducing mastectomy (CRRM) should
be offered. CRRM is associated with a decreased risk of contralateral
breast cancer; there is insufficient evidence for improved survival.
(Moderate recommendation; FC-I)
Note: The following factors should be considered for assessing risk of CBC and role of
risk-reducing mastectomy: 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.
