The U.S. Preventive Services Task Force (USPSTF) recently updated recommendations for women at risk for breast cancer.
Women with BRCA mutations—who have a much higher likelihood of developing breast and ovarian cancer—are advised to start screening earlier, and some may decide to take preventive medications or undergo prophylactic mastectomy or ovary removal.
The task force recommends that women with a personal or family history of BRCA-related cancers or an ancestry associated with harmful BRCA mutations should be evaluated using a brief risk-assessment tool. If this suggests elevated risk, they should receive genetic counseling and, if indicated, a genetic test for the mutations.
However, the experts recommend against routine risk assessment, counseling and genetic testing for women without these predisposing factors.
In a separate recommendation, the task force advised that clinicians should offer preventive hormone therapy (selective estrogen receptor modulators, such as tamoxifen, or aromatase inhibitors) to women with an elevated risk of developing breast cancer due to factors such as family history or BRCA mutations.
But these meds can cause side effects, including hot flashes and bone loss, so women who are not at increased risk should not use them.
“There are medications available that can help some women prevent breast cancer, but they are not for everyone,” says task force member Michael Barry, MD, of Harvard Medical School.