This month, the U.S. Preventive Services Task Force (USPSTF) updated their recommendations on prevention of BRCA-related cancers.
The new recommendations, published in the Journal of the American Medical Association (JAMA), expand upon previous guidelines developed in 2013 and now include recommendations for individuals of high-risk ancestry. What does this mean for Jewish women? We’ll
break it down.
What is the U.S. Preventive Services Task Force?
The USPSTF is an independent, volunteer panel that provides evidence-based recommendations on what preventive services primary care clinicians should offer their patients. The Task Force assigns letter grades to each service it reviews to indicate the balance of expected benefits and harms,
as well as the level of certainty based on scientific evidence.
Interventions with the grades A or B are recommended, and the Affordable Care Act requires private insurers to cover those services with no cost-sharing (i.e., there is no out-of-pocket cost to the patient). The Affordable Care Act also requires Medicaid to cover those services and
authorizes Medicare to do so.
What did they recommend before?
The USPSTF previously recommended that primary care providers screen women with a family history of breast, ovarian, tubal, or peritoneal cancer to identify whether they are appropriate candidates for genetic counseling and possibly BRCA testing.
This screening involves the clinician going through a risk assessment questionnaire or checklist. The risk assessment can identify a family history suggestive of a possible BRCA1/2 mutation. If screening indicates that hereditary cancer may run in a patient’s family, her
primary care provider should then refer her to genetic counseling.
What are they recommending now, and how is it different?
The updated recommendation adds women who have ancestry
associated with BRCA1/2 gene mutations and women with a personal history of breast, ovarian, tubal, or peritoneal cancer to the list of those who primary care providers should screen for hereditary cancer risk. The recommendation does not specifically mention any ethnicity or ancestry, but
Ashkenazi Jewish ancestry is most strongly associated with BRCA1/2 mutations. 1 in 40 women of Ashkenazi ancestry carries a BRCA1/2 mutation compared to about 1 in 300 women in the general population.
What does this mean for you?
Primary care providers and women’s healthcare providers often already ask their female patients about family history of cancer. This recommendation encourages them to also ask about ethnicity and prior personal cancer diagnoses and use that information to initiate screening for hereditary
cancer risk. If you meet the criteria, most insurance should cover this screening with no out-of-pocket cost to you. These recommendations apply to anyone assigned female at birth, as BRCA-related cancer risks are tied to biological sex.
The risk assessment screening relies on information about family health history, so the screening is most effective if you know about any history of cancer in your parents, grandparents, aunts, uncles, siblings, and children, including their age at diagnosis.
You can find family health history tools on the Sarnoff Center website.
If you are a woman with Ashkenazi Jewish ancestry and you have not yet discussed hereditary cancer risk with your primary care provider, your next checkup is a great time to start the conversation—and to mention that you have Ashkenazi Jewish ancestry.
For additional information and discussion of this change see:
A flow chart below describes the updated recommendation.