BRCA Testing in Serbia and Montenegro

Serbia and Montenegro is the most recent country to have joined the European integration processes in the Western Balkan region. War has troubled this country for more than ten recent years. Postwar conditions have been as severe as those during the war and include poverty and a lack of new, highly sophisticated technologies and trained professionals as well as appropriate organisation of the health services. Knowledge of the molecular basis of hereditary disorders has greatly expanded during the last ten years and the principle of genetic testing has been introduced into the clinical practice of Western countries. In these countries, with the USA being among the first, genetic testing for known germline mutations associated with high lifetime cancer risk, for example those involved in familial adenomatous polyposis, introduced the use of consensus data into medical practice. Simultaneously, inventories (maps) of hereditary disorders with frequency and spectra of gene mutations causing particular hereditary diseases were constructed in the majority of European countries. The delay in transition and European integration of our country has reflected also on the status of the investigation of hereditary disorders, including hereditary breast and ovarian cancer (HBOC), resulting in the fact that our country is currently without such a national inventory of its hereditary disorders. Breast cancer is one of the most common cancers diagnosed in women worldwide and a leading cause of female cancer-related death, despite improvements made in the field of risk factor definition, early detection, diagnostics and treatment of the disease. In central and southeastern European countries, incidence and mortality trends also show an increment, due to recent changes in risk factors (smoking, age at menarche, age at first pregnancy, oestrogen intake, etc.). In Serbia and Montenegro, breast cancer is the most frequent malignancy and the leading cause of cancer-related death in females as well, with a reported mortality rate of 16.9 (ASR w) in the year 2000 [1]. Approximately 3,900 new cases of breast cancer are detected in Serbia and Montenegro each year. Twelve hundred of these cases are newly diagnosed at the Institute of Oncology and Radiology of Serbia. A subset of breast cancer patients with striking family histories is suggestive of Mendelian inheritance of breast cancer risk factors and represents hereditary breast cancer (HBC). About 5 to 10% of all breast cancers are considered to be hereditary. The most common variant of HBC is hereditary breast and ovarian (HBOC) syndrome. BReast …