Which management approach is most appropriate for individuals with BRCA1/2 mutations?

• A. Enhanced surveillance with MRI and risk-reducing surgery (eg, salpingo-oophorectomy)
• B. Lumpectomy is the standard approach for all BRCA carriers
• C. Hormone replacement therapy is the primary risk-reduction strategy
• D. No surveillance is needed after a positive BRCA test

Answer: (C)

Mutations in BRCA1/BRCA2 markedly raise the risk of breast and ovarian cancers, so management focuses on both early cancer detection and risk reduction. Enhanced surveillance with breast MRI offers higher sensitivity than standard imaging in high-risk individuals, and is typically used in combination with regular mammography to catch cancers at an earlier, more treatable stage.

A central risk-reducing measure is prophylactic salpingo-oophorectomy—removing the ovaries and fallopian tubes—which dramatically lowers ovarian cancer risk and also reduces breast cancer risk when done before menopause. The timing is usually after childbearing is complete and tailored to the individual’s risk profile and preferences.

Hormone replacement therapy is not a primary strategy to reduce cancer risk; it may be used to manage menopausal symptoms after oophorectomy but does not provide cancer risk reduction. Lumpectomy, while an option for some breast cancers, is not considered the standard for all BRCA mutation carriers due to the ongoing risk of new primary cancers elsewhere in the breast or the contralateral breast.