How do you approach the discussion about the potential risks of radiation therapy exposure and the development of secondary malignancies for patients with germline BRCA1/2 mutations?  

It appears that the risk of secondary malignancies due to radiation exposure does not seem significantly enhanced in gBRCA-m carriers, unlike patients with Li-Fraumeni syndrome (for whom we would attempt to avoid radiation). The data on mBRCA-associated breast cancers would suggest that radiation is...

Generally, I agree with Drs. @Sikov and @Elias that the decision to apply any preventive therapy involves weighing the risks and benefits of that therapy. We offer adjuvant radiation after breast cancer surgery to decrease the risk of local recurrence. It is recommended when the benefit of decreasin...

I believe that the benefit of breast and regional nodal irradiation in terms of reducing the risk of local or regional recurrence typically outweighs the risk of secondary breast or soft tissue malignancies, though I might favor omitting this treatment in a patient with likely marginal benefit from ...

In short, the value of RT in the adjuvant setting (in terms of local control and preventing recurrence) outweighs the negative effects from RT-induced malignancy. Secondly, it helps to know the BRCA status before primary therapy, so it can be used in shared decision-making, which is an important po...