Breast cancer primary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mirdula Sharma, MBBS [2] Soroush Seifirad, M.D.[3]

Overview

Avoiding risk factors and increasing protective factors may help prevent cancer.

Prevention

There are a number of known risk factors and protective factors for developing breast cancer.[1]

  • The following are known risk factors of developing breast cancer:
  • Older age
  • A personal history of breast cancer or benign (noncancer) breast disease
  • A family history of breast cancer
  • Inherited gene changes
  • Dense breasts
  • Exposure of breast tissue to estrogen made in the body
  • Taking hormone therapy for symptoms of menopause
  • Radiation therapy to the breast or chest
  • Obesity
  • Drinking alcohol
  • Being white
  • The following are protective factors for breast cancer:
  • Less exposure of breast tissue to estrogen made by the body
  • Taking estrogen-only hormone therapy after hysterectomy, selective estrogen receptor modulators, or aromatase inhibitors and inactivators
  • Estrogen-only hormone therapy after hysterectomy
  • Selective estrogen receptor modulators: In the MORE trial, the relative risk reduction for raloxifene was 76%.[2] The P-1 preventative study demonstrated that tamoxifen can prevent breast cancer in high-risk individuals. The relative risk reduction was up to 50% of new breast cancers, though the cancers prevented were more likely estrogen-receptor positive (this is analogous to the effect of finasteride on the prevention of prostate cancer, in which only low-grade prostate cancers were prevented).[3][4]
  • Aromatase inhibitors and inactivators
  • Risk-reducing mastectomy: Bilateral prophylactic mastectomies have been shown to prevent breast cancer in high-risk individuals, such as patients with BRCA1 or BRCA2 gene mutations. [5]
  • Ovarian ablation: Prophylactic oophorectomy (removal of ovaries), in high-risk individuals, when child-bearing is complete, reduces the risk of developing breast cancer by 60%, as well as reducing the risk of developing ovarian cancer by 96%.[5]
  • Getting enough exercise

References

  1. Breast Cancer. National Cancer Institute (2015) http://www.cancer.gov/types/breast/patient/breast-prevention-pdq#section/_12 Accessed on January 15, 2016
  2. Cummings SR, Eckert S, Krueger KA; et al. (1999). "The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple Outcomes of Raloxifene Evaluation". JAMA. 281 (23): 2189–97. PMID 10376571.
  3. Fisher B, Costantino JP, Wickerham DL; et al. (2005). "Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study". J. Natl. Cancer Inst. 97 (22): 1652–62. doi:10.1093/jnci/dji372. PMID 16288118.
  4. Fisher B, Costantino JP, Wickerham DL; et al. (1998). "Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study". J. Natl. Cancer Inst. 90 (18): 1371–88. PMID 9747868.
  5. 5.0 5.1 Kauff N, Satagopan J, Robson M, Scheuer L, Hensley M, Hudis C, Ellis N, Boyd J, Borgen P, Barakat R, Norton L, Castiel M, Nafa K, Offit K (2002). "Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation". N Engl J Med. 346 (21): 1609–15. PMID 12023992.

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