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Invited Critique |

Effect of Genetic Cancer Risk Assessment on Surgical Decisions at Breast Cancer Diagnosis—Invited Critique

Dimitrios H. Roukos, MD
Arch Surg. 2003;138(12):1329. doi:10.1001/archsurg.138.12.1329.
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The evident high lifetime risk of breast cancer (45%-85%) and ovarian cancer (15%-40%) in BRCA1 or BRCA2 mutation carriers has established a form of genetic testing essential for decision making between risk-reducing bilateral mastectomy or oophorectomy1 and surveillance. Now, Weitzel and colleagues correctly highlight the utility of GCRA not only for preventive interventions but also for therapeutic decision making in women who have breast cancer and a strong family history or early-onset disease. Indeed, GCRA before definitive treatment of such patients may change the current choice from BCT to bilateral mastectomy. In sporadic breast cancer, an association has been suggested between multicentricity or multifocality and local failure after BCT in younger as oppposed to older patients.2 This well-established increased risk for young women may partially be attributable to undiagnosed BRCA1 or BRCA2 mutations in some women with early-onset disease.

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