High Risk Assessment and Breast Cancer Prevention are exciting topics for cancer researchers. There are currently options for prevention and therefore we are searching for the best way to assess risk so that we can apply prevention methods to the appropriate population.
Assess your risk:Cancer.gov Risk Assessment Tool
Healthy Lifestyle We advise women to maintain a healthy lifestyle, eating plenty of fruits and vegetables, limiting animal fats and limiting alcohol. Exercise is advised; regular exercise has been shown to reduce your risk of developing breast cancer.
Screening and early detection have improved breast cancer survival. Yearly mammogram after age 40 is recommended. Added imaging with ultrasound or breast MRI might be indicated for some women at high risk. Your doctor can help determine if other imaging would be helpful in your situation. Women with increased breast density (defined as greater than 50% density on mammography) may benefit for additional screening with ultrasound. In Vermont, mammographers are mandated to notify women of their breast density. Please read the below links explaining the recommendation for yearly mammograms.
- ASBS Mammography Consensus – American Society of Breast Surgeons Statement
- UVMMC Information on Breast Density
Prophylactic surgery is an option chosen by some women in the highest risk category, such as women with a genetic mutation of the BRCA 1 or BRCA 2 genes. Prophylactic mastectomy is 90+% effective in preventing breast cancer. Removing a woman’s ovaries can also be protective against breast cancer, reducing risk by 50%.
Chemoprevention, or medication to reduce cancer risk, is available. Two “Synthetic Estrogen Receptor Modulators” or SERM’s are available and can reduce a woman’s risk by 50% or more in select subsets. Tamoxifen and Raloxifene have been studied in prevention trials in high risk women. Tamoxifen is approved for this use in both pre- and post-menopausal women and Raloxifene is approved for post-menopausal women. The Aromatase inhibitors have also been proven to reduce risk of breast cancer in post menopausal women.
Genetic Testing is available for women with very strong family histories, breast cancer at a young age and women with bilateral breast cancer. The following websites provide excellent information for BRCA 1 and BRCA 2 mutation carriers.
- www.facingourrisk.org
www.sharsheret.org - ASBS Statement Regarding Genetic Testing
- UVM Familial Cancer Program
Ask your doctor if referral to a genetic counselor is appropriate for your personal and family history.
Risk Assessment, Prevention and available research studies are available through
Breast Cancer Risk Assessment via National Cancer Institute
High Risk Breast Program of Vermont
Mary Stanley MD 