# Management of Hereditary Breast Cancer: American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Guideline

Source: https://onco.cc/key-papers/paper-asco-hereditary-breast-cancer-guideline-jco-2020/  
OnCo record `paper-asco-hereditary-breast-cancer-guideline-jco-2020` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The 2020 joint US guideline for breast cancer in people who carry an inherited fault in BRCA1, BRCA2 or another risk gene: breast-conserving surgery is allowed, bilateral mastectomy should be discussed, platinum beats taxanes in advanced disease and PARP inhibitors beat single-agent chemotherapy.

## Summary

Guideline from ASCO, ASTRO and SSO by Tung, Boughey, Pierce, Robson and colleagues, based on 58 articles for local therapy and six randomised trials of systemic therapy. Recommendations: patients with newly diagnosed breast cancer and BRCA1/2 mutations may be considered for breast-conserving therapy with local control similar to non-carriers; the risk of contralateral and new ipsilateral cancers, especially in young women, warrants discussion of bilateral mastectomy; nipple-sparing mastectomy is reasonable; there is no evidence of increased toxicity or contralateral cancers from radiation in BRCA1/2 carriers; radiation should not be withheld in ATM carriers; mastectomy is advised and radiation contraindicated except at high locoregional risk for germline TP53 carriers. Platinum agents are recommended over taxanes for advanced disease in BRCA carriers; routine platinum is not supported in the adjuvant or neoadjuvant setting; PARP inhibitors (olaparib, talazoparib) are preferable to non-platinum single-agent chemotherapy for advanced disease; data were insufficient for early-setting PARP inhibition or moderate-penetrance carriers.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: tnbc-evidence
- Journal: Journal of Clinical Oncology
- Year: 2020
- DOI: 10.1200/JCO.20.00299
- Authors: Tung NM, Boughey JC, Pierce LJ, et al.
- Findings: Breast-conserving therapy is an option for BRCA1/2 carriers; bilateral mastectomy should be discussed because of contralateral and new ipsilateral risk.; Platinum agents recommended over taxanes for advanced disease in BRCA carriers; PARP inhibitors preferable to non-platinum single-agent chemotherapy.; Data insufficient in 2020 for adjuvant PARP inhibition, later supplied by OlympiA.
- What it means: Sets the surgical and systemic rules for the one in nine to one in six triple-negative patients who carry a germline BRCA variant (11 to 17 percent by cohort); the adjuvant gap it named was filled by OlympiA the following year.
- Caveats: Predates OlympiA; adjuvant olaparib is not addressed.; Local therapy evidence is observational.

## Sources

- J Clin Oncol 2020: https://doi.org/10.1200/JCO.20.00299
- PubMed: https://pubmed.ncbi.nlm.nih.gov/32243226/

## Connected records

- cancers: [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- technologies: [Germline (hereditary) testing](https://onco.cc/technologies/germline-testing/), [PARP inhibitors](https://onco.cc/technologies/parp-inhibitor/), [Platinum agents](https://onco.cc/technologies/platinum/)
- targets: [BRCA1 / BRCA2 (HRD)](https://onco.cc/targets/brca/)
- drugs: [Carboplatin](https://onco.cc/drugs/carboplatin/), [Olaparib](https://onco.cc/drugs/olaparib/), [Talazoparib](https://onco.cc/drugs/talazoparib/)
- institutions: [American Society of Clinical Oncology (ASCO)](https://onco.cc/institutions/asco/)
- trials: [EMBRACA](https://onco.cc/trials/embraca/), [OlympiA](https://onco.cc/trials/olympia/), [OlympiAD](https://onco.cc/trials/olympiad/)
- people: [Mark E. Robson](https://onco.cc/people/mark-robson/)
- bottlenecks: [Inherited risk is mostly unidentified](https://onco.cc/bottlenecks/b-hereditary-risk/)
- journals: [Journal of Clinical Oncology](https://onco.cc/journals/jco/)
- roadmaps: [Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem](https://onco.cc/roadmaps/tnbc-roadmap/)
- ideas: [A UK audit of trial access and germline testing uptake in triple-negative breast cancer](https://onco.cc/ideas/idea-tnbc-uk-trial-access-and-germline-testing-audit/)

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