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Decreasing Risk of Breast Cancer
March 2000

Q. I am 35 years old. My mom had breast cancer at 45 years of age. What can I do to decrease my chances of getting breast cancer?

A. Good question! There is a lot of research currently going on to help with this very important issue. Fortunately, there are several things you can do. First, although the American Cancer Society (ACS) advises annual mammogram and breast exam by your physician each year beginning at age 40, in your case, I would begin now. It is my practice to begin cancer screening about 10 years before a first degree relative was diagnosed with their cancer. Although it is unclear if breast self exam each month actually prolongs survival, I still think it makes sense to do this. Second, it is important to try to maintain normal body weight. There is some data to suggest obesity is a risk factor for some cancers including breast. Also, consider having children, if you don't already. Not having any breaks in estrogen production increases the risk of breast cancer.

Now there is a medication Tamoxifen, that has been shown to decrease the risk of developing breast cancer and has recently become FDA approved for use in women who are at increased risk of developing breast cancer. There is a set of criteria called the Gail Model that takes into consideration many different risk factors and calculates the probability of developing breast cancer. If one's risk is high enough, it is reasonable to use this med for prevention. The risk of breast cancer in these patients can be reduced by about 50% with Tamoxifen. However, there can be some significant adverse effects. First, if you have a history of blood clots or are on a blood thinner Coumadin, you should not take Tamoxifen. Also, there is an increased risk of uterine cancer and developing blood clots, along with hot flashes. Benefits, must be weighed against the risks.

Also, there are some genetic tests that can be done to check for BRCA1 and BRCA2 gene mutations. However, the accuracy of these tests is limited and more studies are needed to help guide us how to best use these tests in clinical practice. For example, if one is BRCA1 or 2 positive, should they have prophylactic bilateral mastectomy (Both breasts removed preventively, before any cancer is evident)? We do not know the answer to that question currently. Hopefully better alternative preventive measures will be available in the near future.

For more info: National Alliance of Breast Cancer Organizations: 1-212-719-0154

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