Managing healthcare for female BRCA carriers in the population screening era: developing a harmonized national policy for surveillance and risk-reduction
Year: 2026
Type: article
Abstract: BACKGROUND: The implementation of Israeli National screening for BRCA1/BRCA2 pathogenic variants (PVs) in 2020 has led to a significant increase in the number of unaffected female carriers who are referred to high-risk surveillance clinics (HRSCs). Lack of standardization in protocols for risk reduction and surveillance between HRSCs results in confusion and gaps in care. We aimed to identify discrepancies in existing practices and lead to policy development of a national policy for surveillance, management and risk reducing strategies in BRCA-PV carriers. METHODS: A comparative analysis of risk reduction and surveillance protocols of the nine leading HRSCs across Israel, comprising the Israeli Consortium for hereditary breast and ovarian cancer (HBOC), and multi-center meetings to develop consensus guidelines for HRSCs. RESULTS: Our analysis revealed a high level of prior consensus on critical aspects including risk-reducing mastectomy, salpingo-oophorectomy, fertility treatment, contraception, hormone replacement therapy, and general health behavior. For breast cancer (BC) imaging surveillance there was variability regarding frequency (e.g. only one HRSC offers biannual MRI for BRCA1 carriers), age limits (five centers continue in women older than 75 years), frequency during pregnancy and lactation (four HRSCs every three months and four others every six months; one does not recommend any surveillance), and surveillance post-mastectomy. For ovarian cancer (OvCa) surveillance, there was also variability: six centers recommend biannual/annual serum CA-125 level and pelvic sonography for all women, one center recommends this for all women till risk-reducing-bilateral-salpingo-oophorectomy (RRBSO), and two centers exclusively for women from age 35 till RRBSO. Surveillance recommendations for malignancies other than BC and OvCa differed greatly among centers.
Authors: Rachel Michaelson-Cohen, Shunit Armon, Naama Srebnik, Einat Koller Volkow, Pnina Mor, David Gekhtman, Ora Rosengarten, Adi Maisel Lotan, Hadar Goldvaser, Yahelli Miller, Dana Madorsky Feldman, Rinat Bernstein Molho, Miri Sklair Levy, Inbal Kedar, Yael Goldberg, Yael Raz, Sharon Simchoni, Aviad Hoffman, Miora Linial, Einat Carmon, Inbar Gatot, Michal Braha, Rakefet Chen Shtoyerman, Shikma Mordechai, Elizabeth E. Half, Lior Katz, Zohar Levi, Sharon Bratman Morag, Tanir M. Allweis, Eitan Friedman, Ephrat Levy-Lahad, Sari Lieberman
Institutions: Hebrew University of Jerusalem, Shaare Zedek Medical Center, Bikur Cholim Hospital, Memorial Sloan Kettering Cancer Center, Sheba Medical Center, Tel Aviv University, Rabin Medical Center, Tel Aviv Sourasky Medical Center, Technion – Israel Institute of Technology, Rambam Health Care Campus, Assuta Medical Center, Assaf Harofeh Medical Center, Kaplan Medical Center, Ariel University, Rebecca Sieff Hospital, Hadassah Medical Center
Language: English
Subfield: Genetics
Domain: Life Sciences
Open Access status: diamond
Awards: G6566389800, G8971741632
OpenAlex ID: W7126027372