Know Your Breast Cancer Prevention Options
July 20, 2000 -- If you have a personal or family history of breast cancer -- or a genetic predisposition to it -- you need to know your options. There are steps you can take to lessen your risk of getting the disease, but figuring out which one is best for you can be confusing.
That's because much of the information that is needed to make appropriate decisions has come from small studies or from trials that are still in progress.
"I would agree that it is a confusing issue for patients and physicians," says Rowan T. Chlebowski, MD, PhD, who wrote an article on the subject in the July 20 issue of The New England Journal of Medicine. "Some of this is really just going forward for the first time."
Right now, the options for women considered to be at high risk of breast cancer are having their breasts removed in what is known as a prophylactic mastectomy, or taking the drug tamoxifen, which has been shown to decrease future risk of breast cancer in some women.
In general, the author points out, a woman's risk of breast cancer is affected by the levels of hormones she has naturally or receives. Removal of the ovaries also has been shown to reduce the risk of developing breast cancer in selected women who have not entered menopause and who have decided to not have further pregnancies. Both surgical procedures can't be reversed, and women need to be counseled about the short- and long-term effects and benefits.
In order to be considered a candidate for tamoxifen therapy, a woman's riskof breast cancer in the near future must be calculated and found to beunacceptably high. In an attempt to improve on the available therapies, raloxifene andtamoxifen are being studied in postmenopausal women as part of a large trialtaking place in 500 centers in the U.S., Puerto Rico, and Canada.
What can be done for women who cannot take or choose not to take thosedrugs?
Prophylactic mastectomy is an available option, but it is controversial. Deborah Axelrod, MD, chief of the Comprehensive Breast Center at Saint Vincent's Medical Center in New York, points to an article in this week's Journal of the American Medical Association in which more than 600 women with a family history of breast cancer had both breasts removed from 1960 to 1993.
"The gist of the article is that people were happy years after having it done," she says. But Chlebowski, with the Harbor-UCLA Research and Education Institute in Torrance, Calif., says other studies show that 5 to 20% of women may have at least some dissatisfaction after the procedure, often due to breast numbness and absence of nipple sensation.
Other less proven options are lifestyle changes, such as adhering to a low-fat diet, getting regular exercise, losing weight if needed, cutting back on alcohol, and not smoking. Some studies have suggested that these things may reduce breast-cancer risk, and most doctors think they're reasonable. But proof that they work may be years away. A large study called the Women's Health Initiative, which includes more than 47,000 postmenopausal women, is looking at whether diet affects breast cancer risk, but those results won't be in until about five years from now.