Recommendations for Women with BRCA1 or BRCA2 mutations (Hereditary Breast Ovarian Cancer Syndrome)
The following are guidelines to help lower your chances of developing breast or ovarian cancer or find cancer at an early stage. Screening recommendations typically begin at age 25 to 30 unless otherwise noted; in some cases an earlier start may be indicated.

Breast cancer screening and risk reduction basics:

• Begin breast self-exam monthly at age 18 years 
• Breast exam every 6 months by a healthcare professional starting at age 25 years
• Mammogram every 12 months, starting at age 25 years 
• Breast MRI every 12 months, especially if there is high mammographic density and/or exceptional complexity to the clinical breast exam

More proactive breast cancer prevention strategies in high-risk women:

• Consider Bilateral mastectomy (risk reduction mastectomy expected to reduce risk by more than 90 percent), with reconstruction as desired
• Consider Tamoxifen or raloxifene (Evista) – oral medications that may reduce breast cancer risk by about 50 percent
• Clinical trials of risk reduction interventions may also be available

Ovarian cancer risk-reduction/screening:

• Removal of both ovaries and fallopian tubes between ages 35-40 or after completion of childbearing, because of limitations in the surveillance methods to detect early stage ovarian and fallopian tube cancers. 
• Women who have not had this surgery are recommended to have transvaginal ultrasound with color Doppler every six months (timed to avoid ovulation in order to reduce the frequency of false-positive results) and a
• CA-125 blood test every six months
• Taking oral contraceptives – many studies demonstrate significant reduction in ovarian cancer, especially in formulations containing higher progestin levels.

The above recommendations and options should be discussed with a health care provider who has expertise in the management of hereditary cancers so they can be personalized to the individual and her family history. In addition, it is recommended standard screening guidelines for early detection of other cancers be followed. Refer to the American Cancer Society recommendations at www.cancer.org.

*Based on the NCCN 2010 guidelines