{"entity":{"id":"paper-asco-hereditary-breast-cancer-guideline-jco-2020","kind":"paper","name":"Management of Hereditary Breast Cancer: American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology Guideline","aka":[],"tldr":"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.","asOf":"2026-09-24","links":[{"label":"J Clin Oncol 2020","url":"https://doi.org/10.1200/JCO.20.00299"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/32243226/"}],"tags":["tnbc-evidence"],"related":[],"cancers":["tnbc","breast-hr-positive"],"sections":[],"technologies":["parp-inhibitor","platinum","germline-testing"],"targets":["brca"],"drugs":["olaparib","talazoparib","carboplatin"],"companies":[],"institutions":["asco"],"pathways":[],"terms":["germline-testing"],"trials":["olympiad","embraca","olympia"],"people":["mark-robson"],"bottlenecks":["b-hereditary-risk"],"keyPapers":[],"journals":["jco"],"dependsOn":[],"notes":[],"journal":"Journal of Clinical Oncology","year":2020,"doi":"10.1200/JCO.20.00299","pmid":"32243226","authors":"Tung NM, Boughey JC, Pierce LJ, et al.","paperType":"guideline","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."],"whatItMeans":"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."],"changedPractice":true},"route":"/key-papers/paper-asco-hereditary-breast-cancer-guideline-jco-2020/","neighbours":{"cancer":[{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"}],"technology":[{"id":"germline-testing","kind":"technology","name":"Germline (hereditary) testing","route":"/technologies/germline-testing/"},{"id":"parp-inhibitor","kind":"technology","name":"PARP inhibitors","route":"/technologies/parp-inhibitor/"},{"id":"platinum","kind":"technology","name":"Platinum agents","route":"/technologies/platinum/"}],"target":[{"id":"brca","kind":"target","name":"BRCA1 / BRCA2 (HRD)","route":"/targets/brca/"}],"drug":[{"id":"carboplatin","kind":"drug","name":"Carboplatin","route":"/drugs/carboplatin/"},{"id":"olaparib","kind":"drug","name":"Olaparib","route":"/drugs/olaparib/"},{"id":"talazoparib","kind":"drug","name":"Talazoparib","route":"/drugs/talazoparib/"}],"institution":[{"id":"asco","kind":"institution","name":"American Society of Clinical Oncology (ASCO)","route":"/institutions/asco/"}],"trial":[{"id":"embraca","kind":"trial","name":"EMBRACA","route":"/trials/embraca/"},{"id":"olympia","kind":"trial","name":"OlympiA","route":"/trials/olympia/"},{"id":"olympiad","kind":"trial","name":"OlympiAD","route":"/trials/olympiad/"}],"person":[{"id":"mark-robson","kind":"person","name":"Mark E. Robson","route":"/people/mark-robson/"}],"bottleneck":[{"id":"b-hereditary-risk","kind":"bottleneck","name":"Inherited risk is mostly unidentified","route":"/bottlenecks/b-hereditary-risk/"}],"journal":[{"id":"jco","kind":"journal","name":"Journal of Clinical Oncology","route":"/journals/jco/"}],"roadmap":[{"id":"tnbc-roadmap","kind":"roadmap","name":"Triple-negative breast cancer roadmap: from a remainder defined by three negative tests to immunotherapy, antibody-drug conjugates and the residual disease problem","route":"/roadmaps/tnbc-roadmap/"}],"idea":[{"id":"idea-tnbc-uk-trial-access-and-germline-testing-audit","kind":"idea","name":"A UK audit of trial access and germline testing uptake in triple-negative breast cancer","route":"/ideas/idea-tnbc-uk-trial-access-and-germline-testing-audit/"}]}}