Breast Program

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.