Authors' objectives:

1) To quantify the differences in terms of reducing breast and gynecologicalal cancer incidence and/or mortality in women carrying BRCA1/2 mutations when comparing different strategies for preventive purposes with each other, including placebo or no intervention as valid options to compare. Through the papers selected to achieve this objective, it was considered to describe other kind of health results (other cancers incidence, mortality caused by all causes, physical and psychological morbidity, quality of life, etc.) related to any preventive intervention strategy.
2) To determine accuracy parameters (sensitivity and specificity) of surveillance programmes and diagnosis techniques used for early detection of cancer in women carriers of BRCA1/2 mutations.

Authors' recommendations: There can be affirmed with the results from this review that there is not enough evidence on the benefits of chemoprevention and intensive surveillance in women carriers of BRCA1/2 mutations. Regarding prophylactic surgery (PM and PGC), a reduction effect in breast and gynecological cancer incidence has been found in the before mentioned women. However, these results must be interpreted cautiously. There must be taken into account that no increase in survival was proven, that all studies assessed have methodological flaws, and that there are constraints to interprete their external validity. In addition none of these preventive interventions lacks risks, and protection against breast and gynecological cancer, as well as against other cancers linked to BRCA mutations is not complete. In breast cancer screening in women carriers of BRCA gene mutations, NMR was the technique that achieved greater sensitivity, and the programmes incorporating such imaging technique formally for all study women got a higher diagnostic output. However, NMR is an expensive test with a low positive predictive value, and until now, it is unknown if screening with NMR reduces mortality in the study population. Concerning output of screening programmes for gynecological cancer in women carriers of BRCA gene mutations, no sound conclusions can be taken given the lack of information in this respect.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.juntadeandalucia.es/salud/orgdep/aetsa/descarga.asp?id=109

Year Published: 2007

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Andalusian Health Technology Assessment Area

Contact Address: Area de Evaluacion de Tecnologias Sanitarias Sanitarias de Andalucia (AETSA) Avda. Innovación, s/n Edificio Arena 1. Sevilla (Spain) Tel. +34 955 006 309

Contact Name: aetsa.csalud@juntadeandalucia.es

Contact Email: aetsa.csalud@juntadeandalucia.es

Copyright: Andalusian Agency for Health Technology Assessment (AETSA)