Women whose family histories include certain types of cancer, or an ancestry associated with BRCA1 or BRCA2 mutations, should be assessed for increased risk of those mutations, the U.S. Preventive Services Task Force (USPSTF) concluded in a final recommendation statement on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer that will increase the number of women who should be screened.
“The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with BRCA1/2 gene mutations with an appropriate brief familial risk assessment tool,” the USPSTF said in a Recommendation statement published this week in JAMA.
According to the Task Force, less than 1% of all women have a mutation in either of the BRCA genes.
The Task Force’s recommendation included steps that women can take to determine their susceptibility to increased risk for BRCA gene mutations. The first step is talking to a clinician about their personal or family history or ancestry to see if a risk assessment is needed.
Women who are found to be at increased risk should receive genetic counseling and, if indicated after counseling, BRCA testing, the Task Force recommended. That testing should be done only after a woman has discussed the benefits and harms of testing with a trained health professional, the USPSTF advised, since test results cannot always tell a woman if she has a potentially harmful mutation that could lead to cancer.
“Some women can benefit from risk assessment, counseling, and testing, but not all women need these services,” Task Force chair Douglas K. Owens, MD, MS, said in a statement. “We suggest women talk to their clinicians and decide on the best next steps together.”
Owens is a general internist and investigator at the Center for Innovation to Implementation at the Veterans Affairs Palo Alto Health Care System in California. He is also the Henry J. Kaiser, Jr., professor at Stanford University, where he is a professor of medicine.
Added Task Force member Carol M. Mangione, MD, MSPH: “Because these tests are not without harms, testing for BRCA mutations in women without these risk factors is not recommended.”
Mangione is the chief of the Division of General Internal Medicine and Health Services Research, and the Barbara A. Levey, MD, and Gerald S. Levey, MD, endowed chair in medicine at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).
The Task Force has also published its final recommendation statement and corresponding evidence summary on the Task Force website. A draft version of the recommendation statement and evidence review were available for public comment earlier this year.
The Task Force said its latest recommendation was consistent with recommendations published in 2005 and 2013.
The Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.