Evaluation and treatment of BRCA-Positive patients

The recent discovery of the breast cancer-associated genes BRGA1 and BRGA2 has now made it possible to identify individuals who are at a very high risk for the future development of breast cancer. To some extent, however, society has fallen victim to its molecular genetic technology. The significance of these discoveries to the detection, treatment, and prevention of breast cancer cannot be overstated. Nevertheless, the appropriate administration and interpretation of BRCA genetic testing and the treatment of BRCA-positive patients remain controversial issues. Complexities of BRCA testing require that such genetic screening be restricted to selected high- risk patients and that test results be interpreted by a knowledgeable molecular geneticist. Although no medical prophylaxis has been demonstrated to be of benefit in BRCApositive patients, recent evidence suggests that a prophylactic mastectomy, with or without reconstruction, is a reasonable treatment option that substantially reduces cancer risk.