BRCA genetic testing and HBOC management in pancreatic cancer patients

Abstract

We experienced two cases of pancreatic cancer patients with pathogenic variants in the BRCA2 gene, which is a causative gene for hereditary breast and ovarian cancer (HBOC). Case 1 was a woman in her 40s who underwent surgery for pancreatic head cancer with no recurrence after 5 years. Her family history included four maternal relatives with pancreatic cancer. One of which was found at another hospital to have a pathogenic variant in the BRCA2 gene. With the patient's consent, we conducted a BRCA genetic test and detected a pathogenic variant in BRCA2. Case 2 was a woman in her 60s with a history of gastric cancer in her 40s and breast cancer in her 50s. She underwent surgery for pancreatic head cancer, and there was no apparent recurrence after 3 years. Considering her history of breast cancer, we suggested the possibility of HBOC and performed a BRCA genetic test, which revealed a pathogenic variant in BRCA2. Currently, BRCA genetic testing for pancreatic cancer patients is only covered by insurance as a companion diagnostic procedure. Even if the patient or their relatives have HBOC-related cancers, BRCA genetic testing is not covered by insurance. In the future, it is desirable to establish appropriate measures for the HBOC management, including BRCA genetic testing in pancreatic cancer patients.