US task force does not recommend routine screening for breast cancer gene mutations

September 05, 2005

PHILADELPHIA -- (Sept. 6, 2005) The United States Preventive Services Task Force issues new recommendations for screening for BRCA1 and BRCA2 gene mutations in the Sept. 6, 2005, issue of Annals of Internal Medicine.

The Task Force does not recommend routine screening for the two BRCA genes, which increase a woman's risk for developing breast and ovarian cancer. The Task Force does recommend screening women with specific family medical histories.

This is the first time that the Task Force, a respected independent panel of experts in prevention and primary care, has addressed a decision about genetic screening.

The recommendations will be posted on Web sites of Annals of Internal Medicine, http://www.annals.org/cgi/content/full/143/5/355, and of the Agency for Healthcare Research and Quality, http://www.ahrq.gov/clinic/uspstf/uspsbrgen.htm.

The BRCA screening recommendations are also the subject of a video news release produced by the American College of Physicians, publisher of Annals of Internal Medicine.

Women without one of the family history patterns listed below have a low probability of having a mutation in BRCA1 or BRCA2.

Examples of family medical histories that increase a woman's risk for inheriting a BRCA1 or BCRA2 mutation: *A first-degree relative is defined as a parent, sibling or child. A second-degree relative is a relative with whom one quarter of an individual's genes is shared (i.e., grandparent, grandchild, uncle, aunt, nephew, niece, half-sibling).

The new USPSTF recommendations apply only to women who do not currently have breast or ovarian cancer, i.e., have not received a diagnosis of breast or ovarian cancer.

About 2 percent of adult women in the United States have family histories that indicate an increased-risk for inheriting mutations in the BRCA genes. But, not all women with these family histories will have inherited a mutation, and not all women with a BRCA mutation will develop breast or ovarian cancer.

Screening for BRCA mutations involves three steps:In an accompanying editorial, "Taking Family History Seriously," Wylie Burke, MD, PhD, professor and chair, department of medical history at the University of Washington, stresses the importance of knowing one's family medical history -- both the mother's and father's history.

Wylie also said, in the editorial, that the new USPSTF recommendations will help primary care doctors and women face the complexities of gene testing: "whether to pursue BRCA testing, the appropriate timing, the best way to involve family members in the testing process and the tradeoffs, and uncertainties involved in the different preventive strategies available to women found to have a BRCA mutation."

The USPSTF, an independent panel sponsored by the Agency for Healthcare Research and Quality, has no authority to mandate that their recommendations be followed. However, many physicians, clinics, insurance companies and professional medical organizations, such as the American College of Physicians, endorse their recommendations or use them to guide patient care.
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Annals of Internal Medicine is published in Philadelphia by the American College of Physicians, the largest medical-specialty organization and second-largest physician group in the United States. ACP members include more than 119,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection and treatment of illnesses in adults, reflected in the organization's trademarked phrase Doctors of Internal Medicine. Doctors for Adults.®

American College of Physicians

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