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Expert guidance on screening for colorectal and pancreatic cancer in BRCA1 and BRCA2 carriers

Due to modest risk estimates and limited data, screening is only recommended when BRCA1/2 carriers also have a family history of colorectal cancer or pancreatic ductal adenocarcinoma.
Pancreas, x-ray hologram. 3D rendering on dark blue background
Pancreas, x-ray hologram. 3D rendering on dark blue background

Drs. Sonia S. Kupfer, Samir Gupta, Jeffrey Weitzel and Jewel Samadder provide their expert opinion on colorectal cancer (CRC) and pancreatic ductal adenocarcinoma (PDAC) risk and screening strategies in BRCA1 and BRCA2 carriers. Read this AGA Clinical Practice Update in the August issue of Gastroenterology: AGA Clinical Practice Update on Colorectal Cancer and Pancreatic Cancer Risk and Screening in BRCA1 and BRCA2 Carriers: Commentary.

Risk estimates and recommendations

After reviewing all available evidence, our experts identify that for CRC there is a 1.5-fold increased risk for BRCA1 carriers, and no increased risk in BRCA2 carriers. The modest increased colorectal cancer risk in BRCA1 carriers is insufficient to recommend earlier or more intensive screening; BRCA carriers with family history of CRC or symptoms should be managed according to current guidelines.

For PDAC, there is evidence to support an approximate two- to six-fold increased risk in BRCA2 carriers ascertained from high-risk families, and risk in BRCA1 carriers is less convincing, with some studies reporting no increased risk and others reporting up to a four-fold increased risk. Screening for pancreatic cancer should be considered in BRCA1 and BRCA2 carriers who have a family history of PDAC. Screening should take place in a high-volume center, preferably in a research setting, to generate more evidence to support and refine screening in high-risk populations, including BRCA1/2 carriers.

Read the full article in the August issue of Gastroenterology