Preventing Breast Cancer
Our understanding of how best to prevent and treat breast cancer has come a long way in the past 30 years, and, as a result, far fewer women now die from the disease. Still, there is no sure way to ward it off. Even a prophylactic mastectomy—the removal of a healthy breast as a way for a woman at high risk to reduce her risk—cannot provide an absolute guarantee because mastectomy inevitably leaves some breast tissue behind and so breast cancer can still develop.
But changes to your lifestyle can help reduce your risk. Studies have linked being obese, being physically inactive, taking two or more alcoholic drinks a day, and using combination hormone therapy after menopause with higher risk. Conversely, some studies have reported that having a first child by the early 20s, being physically active, and eating a diet low in fat and high in vegetables and fruits may lower your risk.
Further, recent studies evaluating drugs known as "chemopreventive agents" have shown that treatment with these drugs can reduce the risk of breast cancer by almost one half in high-risk women. The drug currently approved for this is tamoxifen, which blocks the action of the hormone estrogen, among other effects. Taking tamoxifen carries a risk of certain adverse reactions, however, so women should discuss with their healthcare providers whether the drug is appropriate given their own level of risk.
But since many people with no known risk factors develop the disease anyway, all women—even those with the healthiest lifestyles—will want to be vigilant about being appropriately screened to ensure early detection. Mammography, breast examination by a health professional, as well as breast self-exam can together lead to early detection of cancers. The American Cancer Society recommends that women begin annual screening mammograms starting at age 40, or five to 10 years earlier than the age at which the youngest affected first-degree relative was diagnosed. To determine which screening interval is appropriate and when to begin screening, each woman should consult her doctor.
A prophylactic mastectomy (also called a preventive or risk-reduction mastectomy) involves removing one or both breasts to reduce the risk of developing the disease. This procedure is generally reserved for women who are at very high risk of developing breast cancer.
Prophylactic mastectomy and any subsequent breast reconstruction are major surgical procedures. Although mastectomy significantly reduces the risk of breast cancer in high-risk women, it does not offer a guarantee because it cannot remove all breast tissue, which is widely distributed across the chest wall. Before seriously considering whether to undergo this surgery women need a clear understanding of their own risk and should consider discussing their options with a genetic counselor. Physicians also will help patients assess their risk and discuss the pros and cons of the procedure.
Being identified as high risk does not mean a patient will definitely get cancer, but under certain conditions prophylactic mastectomy may be an appropriate procedure:
Family or personal history: A woman might be a candidate for prophylactic mastectomy if she has had two or more first-degree relatives—mother, sister, or daughter—with the disease, particularly if the relatives were diagnosed before age 50 or had bilateral breast cancer. So might a woman who has already had cancer in one breast. Women who have had cancer in one breast are at a higher risk of developing cancer in the other breast.
Genetic factors: Genetic testing can identify people who have an abnormal breast cancer gene (BRCA1 or BRCA2) associated with an inherited type of breast cancer. Genetic testing also makes sense for individuals with a strong family history of breast cancer (involving multiple women on either side of the family) or other cancers (such as ovarian, colon, or prostate cancer) as well as individuals with a male family member diagnosed with breast cancer.
LCIS (lobular carcinoma in situ): Women with LCIS are five times as likely to develop breast cancer as women who do not have this precancerous condition. A woman with LCIS and a family history of breast cancer is at even higher risk.
advertisement
