Breast Cancer Prevention Guidelines
There are a few prevention strategies that can decrease a woman's chance
of developing breast cancer. These can be recommended based on the relative
risk the woman's family history and other risk factors place her in.
The woman at average risk can reduce her risk of getting breast cancer by:
- Eating a healthy diet high in vegetables and low in fat
- Exercising regularly
- Keeping Vitamin D levels normal through sunshine exposure or supplementation
- Not smoking
The woman who has a moderate risk is someone who has a five-fold increase
in breast cancer or a calculated risk of being diagnosed with breast cancer
that is greater than 1.7% in the next five years. It is also those women
who have a benign biopsy showing atypical ductal hyperplasia (ADH), atypical
lobular hyperplasia (ALH) or lobular carcinoma in situ (LCIS). These women
should be aware of changes in their breasts, have regularly scheduled
mammograms according to guidelines and can use one of three possible medication
choices for prevention: Tamoxifen, Raloxifene (Evista), or Aromasin. These
are agents that reduce the chance of developing breast cancer by 50% but
have side effects that must be considered before starting the medication.
Women at the highest risk, which is considered 10-fold or greater than
20% risk, needs special attention. If they have been tested for BRCA (the
breast cancer gene) and are positive, they have the choice of continued
surveillance with breast MRI and physical exam as well as mammography
or risk reduction mastectomies (removal of all the breast tissue). These
BRCA positive women should also strongly consider having their ovaries
and tubes removed after the age of 35 or when they are done having children.
There are a number of studies looking at Tamoxifen in preventing breast
cancer in patients with a high-risk based on family history or prior premalignant
biopsies. There are situations in which prevention has been shown to be
helpful in the premalignant conditions of ductal carcinoma in-situ and
lobular carcinoma in-situ. Several studies have shown that Tamoxifen will
decrease future breast cancer incidents by about 50% and ongoing trials
with the aromatase inhibitors may show a higher prevention rate than Tamoxifen.