Expired CME Article

Breast Cancer: Risk Assessment and Prevention

Authors: Mary A. Hooks, MD, MBA


Breast cancer is the most common cancer and the second most common cause of cancer death in women. In 2008 there were 182,460 women diagnosed with breast cancer, and 40,480 women died of this disease.1 Breast cancer can be prevented by medical (tamoxifen or raloxifene) or surgical approaches (bilateral mastectomy or oophorectomy). Prevention is only recommended for women at high risk for developing breast cancer; therefore, proper risk calculation is essential in identifying women that may benefit from prevention measures. There is an easy-to-use and easily accessible risk calculation tool for determining a woman's risk of developing breast cancer and need for referral for counseling, gene testing, and possibly preventive therapy. This article reviews the components of risk assessment, the most frequently used risk calculation tool, and approaches to breast cancer risk reduction including medical and surgical therapies. The use of these therapies results in a risk reduction of 50–90%.

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1. Surveillance Epidemiology and End Results, SEER Stat Fact Sheets, Breast Cancer, February 2009. Available at: http://seer.concer.gov/statfacts/html/breast.html. Accessed February 15, 2009.
2. Jemal A, Siegel R, Ward E, et al. Cancer Statistics, 2008. CA Cancer J Clin 2008;58:71–96.
3. Ravdin PM, Cronin K, Howlader N, et al. The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med 2007;356:1670–1674.
4. Breen N, A Cronin K, Meissner HI, et al. Reported drop in mammography: is this cause for concern? Cancer 2007;109:2405–2409.
5. Berry DA, Cronin KA, Plevritis SK, et al; Cancer Intervention and Surveillance Modeling Network (CISNET) Collaborators. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 2005;353:1784–1792.
6. Willey SC, Cocilovo C. Screening and follow-up of the patient at high risk for breast cancer. Obstet Gynecol 2007;110:1404–1416.
7. National Comprehensive Cancer Network. NCCN Practice Guidelines in Oncology, Breast Cancer Risk Reduction–V. 1.2009. Fort Washington, PA, National Comprehensive Cancer Network, Inc., January 2009.
8. Kauff ND, Barakat RR. Risk-reducing salpingo-oophorectomy in patients with germline mutations in BRCA1 or BRCA2. J Clin Oncol 2007;25:2921–2927.
9. Kauff ND, Satagopan JM, Robson ME, et al. Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 mutation. N Engl J Med 2002;346:1609–1615.
10. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 1998;90:1371–1388.
11. Fisher B, Costantino JP, Wickerham DL, et al. 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 2005;97:1652–1662.
12. Vogel VG, Costantino JP, Wickerham DL, et al; National Surgical Adjuvant Breast and Bowel Project (NSABP). Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifen (STAR) P-2 trial. JAMA 2006;295:2727–2741.
13. Pritchard KI. Selective estrogen receptor modulators in the prevention and treatment of breast cancer. Clin Oncol Updates 2001;3:1–15.
14. Armstrong K, Eisen A, Weber B. Assessing the risk of breast cancer. N Engl J Med 2000;342:564–571.
15. Hartmann LC, Sellers TA, Frost MH, et al. Benign breast disease and the risk of breast cancer. N Engl J Med 2005;353:229–237.
16. Singletary SE. Rating the risk factors for breast cancer. Ann Surg 2003;237:474–482.
17. Robson M, Offit K. Clinical practice. Management of an inherited predisposition to breast cancer. N Engl J Med 2007;357:154–162.
18. Travis LB, Hill DA, Dores GM, et al. Breast cancer following radiotherapy and chemotherapy among young women with Hodgkin disease. JAMA 2003;290:465–475.
19. Hodgson DC, Koh ES, Tran TH, et al. Individualized estimates of second cancer risks after contemporary radiation therapy for Hodgkin lymphoma. Cancer 2007;110:2576–2586.
20. Travis LB, Hill D, Dores DM, et al. Cumulative absolute breast cancer risk for young women treated for Hodgkin lymphoma. J Natl Cancer Inst 2005;97:1428–1437.
21. Smith RA. The evolving role of MRI in the detection and evaluation of breast cancer. N Engl J Med 2007;356:1362–1364.
22. Rossouw JE, Anderson GL, Prentice RL, et al; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002;288:321–333.
23. Gail MH, Brinton LA, Byar DP, et al. Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst 1989;81:1879–1886.
24. NCI Website, Breast Cancer Risk Assessment Tool. Available at: http://www.cancer.gov/bcrisktool/. Accessed July 6, 2009.
25. Tamoxifen for early breast cancer: an overview of the randomized trials. Early Breast Cancer Trialists' Collaborative Group. Lancet 1998;351:1451–1467.
26. Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 1999;282:637–644.
27. Land DR, Wickerham DL, Costantino JP, et al. Patient-reported symptoms and quality of life during treatment with tamoxifen or raloxifene for breast cancer prevention: the NSABP Study of Tamoxifen and Raloxifen (STAR) P-2 trial. JAMA 2006;295:2742–2751.
28. Bertagnolli MM. Surgical prevention of cancer. J Clin Oncol 2005;23:324–332.
29. Hartmann L, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med 1999;340:77–84.
30. American Cancer Society (ACS) Website. Available at: http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_breast_cancer_be_prevented_5.asp. Accessed July 6, 2009.