Re-evaluation of Benefits of BRCA1/2 Testing

Article Tools Correspondence Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.1999.17.6.1962 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 10561241 Re-evaluation of Benefits of BRCA1/2 Testing Ellen R. KnellxEllen R. KnellSearch for articles by this author , Cary A. PresantxCary A. PresantSearch for articles by this author Victor R. GrannxVictor R. GrannSearch for articles by this author , William WhangxWilliam WhangSearch for articles by this author , Judith S. JacobsonxJudith S. JacobsonSearch for articles by this author , Daniel F. HeitjanxDaniel F. HeitjanSearch for articles by this author , Karen H. AntmanxKaren H. AntmanSearch for articles by this author , Alfred I. NeugutxAlfred I. NeugutSearch for articles by this author Show More California Cancer Medical Center, West Covina, CAHerbert Irving Comprehensive Cancer Center, Columbia-Presbyterian Medical Center, New York, NY https://doi.org/10.1200/JCO.1999.17.6.1962 First Page Full Text PDF Figures and Tables © 1999 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse01061999In Reply: Drs Knell and Presant call attention to two important points in our recent publication in the February 1999 issue of the Journal of Clinical Oncology.1 In a previous study,2 we modeled the cost effectiveness of prophylactic surgery compared with surveillance for 30-year-old women who are mutation carriers. In the present study, our model indicated that in an Ashkenazi Jewish population with a 2.5% incidence of three specific mutations (not the general population with a mutation risk of less than 0.2%), 30-year-old women who intended to take appropriate preventive interventions if they tested positive for BRCA1/2 would benefit from prophylactic surgery. The model also indicated that waiting to have the surgery would reduce the benefit (increase the cost per life-year saved).We focused our analysis on women with one of the three Ashkenazi Jewish mutations and did not assume that "screening Ashkenazi Jewish women with a family history of cancer will have a higher yield than screening Ashkenazi Jewish women irrespective of family history." We certainly agree that women who test negative for these mutations may still have other mutations or risks of developing breast cancer. Although we did not address counseling, we certainly agree that it is necessary. We also agree that among women who have a strong family history of breast cancer not associated with a known mutation, a negative test result is no guarantee of average risk.As newer mutations are described, we plan to incorporate them into our model. 1. Grann VR, Whang W, Jacobson JS, et al: Benefits and costs of screening Ashkenzai Jewish women for and J Clin Oncol 17::494,1999-500 BRCA1 BRCA2. Link, Google Scholar2. Grann VR, Panageas KS, Whang W, et al: Decision analysis of prophylactic mastectomy and oophorectomy in -positive or -positive patients. J Clin Oncol 16::979,1998-985 BRCA1 BRCA2 Link, Google Scholar