gynecology and obstetrics
Breast Cancer Screening and Prevention
Prevention of Breast Cancer
Measures for breast cancer prevention include Lifestyle modifications Surgery Chemoprevention Some studies have found that eating a healthy diet, maintaining a healthy weight, exercising regularly, and limiting alcohol intake are associated with a decreased risk of breast cancer ( Prevention references ). In addition, patients should be counseled about avoiding modifiable factors that increase risk of breast cancer (eg, Certain high-risk populations (BRCA mutation carriers) may benefit from risk-reducing mastectomy. Chemoprevention withtamoxifen,raloxifene, or an aromatase inhibitor may be indicated for women age ≥ 35 years with the following: Previous lobular carcinoma in situ (LCIS) or atypical ductal or lobular hyperplasia A 5-year risk of developing breast cancer>1.67%, based on the Gail model History of thoracic radiation received at < 30 years old Presence of high-risk mutations (eg,BRCA1orBRCA2mutations, Li-Fraumeni syndrome) A computer program to calculate breast cancer risk by the Gail model is available from the National Cancer Institute (NCI) at 1-800-4CANCER and on theNCI web site. Recommendations of the U.S. Preventive Services Task Force (USPSTF) for chemoprevention of breast cancer are available from theUSPSTFand theAmerican Society of Clinical Oncology. has been found to be effective in premenopausal patients ( Prevention references ). Risks oftamoxifeninclude Endometrial Cancer None Thromboembolic complications Cataracts Possibly stroke Risks are higher for older women. Raloxifeneappears to be about as effective astamoxifenin postmenopausal women and to have a lower risk of endometrial cancer, thromboembolic complications, and cataracts.Raloxifene, liketamoxifen, may also increase bone density.Raloxifeneshould be considered as an alternative totamoxifenfor chemoprevention in postmenopausal women. Osteoporosis is a risk ofaromatase inhibitortherapy. 1.Malcomson FC, Wiggins C, Parra-Soto S, et al: Adherence to the 2018 World Cancer Research Fund (WCRF)/American Institute for Cancer Research (AICR) Cancer Prevention Recommendations and cancer risk: A systematic review and meta-analysis [published online ahead of print, 2023 Jun 13].Cancer10.1002/cncr.34842, 2023. doi:10.1002/cncr.34842 2.Cuzick J, Forbes JF, Sestak I, et al: Long-term results oftamoxifenprophylaxis for breast cancer--96-month follow-up of the randomized IBIS-I trial.J Natl Cancer Inst99(4):272-282, 2007. doi:10.1093/jnci/djk049 3.Nelson HD, Fu R, Zakher B, et al: Medication Use for the Risk Reduction of Primary Breast Cancer in Women: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.JAMA322(9):868-886, 2019. doi:10.1001/jama.2019.5780 4.Vogel VG, Costantino JP, Wickerham DL, et al. Update of the National Surgical Adjuvant Breast and Bowel Project Study ofTamoxifenandRaloxifene(STAR) P-2 Trial: Preventing breast cancer.Cancer Prev Res (Phila)3(6):696-706, 2010. doi:10.1158/1940-6207.CAPR-10-0076 