Consensus Guideline: Treatment Options for Hereditary Breast Cancer
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the recommended surgical treatment for hereditary breast cancer 2. Describe the recommended medical treatment for hereditary breast cancer
Estimated time to complete activity: .25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from through , participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of .25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is .25 contact hours.
American Society of Clinical Oncology (ASCO), American Society for Radiation Oncology (ASTRO), and Society of Surgical Oncology (SSO) have published a guideline for management of individuals with hereditary breast cancer. The guideline was developed to standardize care among individuals carrying a pathogenic mutation, with a focus on BRCA1/2, PALB2, CHEK2, TP53 and ATM germline mutations. The guideline was created by a consensus panel of 52 members, and funded by ASCO.
The majority of breast cancer is sporadic (no family history)
15 to 20% of breast cancer is familial (clustering with significant family history, but no pathogenic mutation identified)
5 to 10% of breast cancer is hereditary and associated with a germline mutation
High penetrance genes such as BRCA1/2 confer a lifetime breast cancer risk of 70%
Moderate penetrance genes confer a lower risk
PALB2: 35 to 60%
ATM and CHEK2: 25 to 30% mutations
Patients with newly diagnosed hereditary breast cancer can be offered breast-conserving therapy (BCT)
Patients who are BRCA1/2 carriers are at increased risk of contralateral breast cancer (CBC)
Discuss the option of bilateral mastectomy (with contralateral risk-reducing mastectomy (CRRM))
Consideration of family history, age at diagnosis, comorbidities, life expectancy and ability for the patient to undergo breast surveillance should be a part of this conversation
Patients who do not have bilateral mastectomy
Offer high-risk screening of the remaining breast tissue with annual mammogram and magnetic resonance imaging
For patients who request CRRM
Nipple-sparing mastectomy (NSM) is a reasonable approach
There is limited evidence for CRRM in patients with moderate-penetrance genes (PALB2, ATM, and CHEK2) | Additional factors can be considered such as age at diagnosis and family history
TP53 mutation carriers
Offer mastectomy because radiation therapy is contraindicated unless the risk of locoregional recurrence is high
Advanced BRCA-associated breast cancer
Platinum agents are recommended versus taxanes
There are no data to address platinum efficacy in other germline mutations
Poly ADP-ribose polymerase (PARP) inhibitors
Recommended for metastatic HER2-negative BRCA-associated breast cancer as an alternative to chemotherapy for first- to third-line therapy
No evidence exists to support the use of PARP inhibitor in patients with moderate penetrance genes
Note: A recent publication in the NEJM supports the role for adjuvant olaparib, a PARP inhibitor, for the treatment of HER2-negative early breast cancer specifically for patients with germline BRCA1 or BRCA2 pathogenic or likely pathogenic variants
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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