Fighting back with risk assessment and prevention
The greatest risk factors for breast cancer are being female and getting older. For women living in the United States, breast cancer is the second most common form of cancer next to skin cancer. It is also the second leading cause of cancer deaths next to lung cancer. The average woman living in the U.S. has approximately a 12 percent (1 in 8) risk for developing breast cancer in her lifetime. The 12 percent estimate is based on an average of risk levels throughout a woman’s life and assumes a life expectancy of 78 years. The greatest risk levels are after the age of 50. Some women have risk factors that put them at a higher risk for breast cancer than the average woman. Risk factors for breast cancer include:
- A history of benign breast biopsies
- Prior history of breast biopsies showing atypical cells
- Family history of breast cancer
- Personal or family history of ovarian cancer
- First menstrual period before 12
- Late age of menopause
- Having a first child after age 30
- Excessive alcohol intake
Based on a person’s risk, a personalized plan of care for breast cancer risk reduction and early detection can be developed for any woman. Risk assessment and prevention programs are designed so that every woman’s individual risk for the development of breast cancer is calculated by using the widely accepted Gail model. This model has been scientifically tested and validated. The Gail model considers your current age, age of onset of your first menstrual period, age of full term pregnancy, number of first degree relatives (mother, sisters, daughters) with breast cancer, the number of breast biopsies, and whether any of those biopsies showed atypical cellular growth. At the end of each visit the information gathered from each individual patient will be reviewed. Subsequently, an early detection and risk reduction plan will be formulated and tailored to the patient’s needs. Genetic counseling and genetic testing for the BRCA1 and BRCA2 mutation is also available through this program when appropriate.
Breast cancer screening guidelines
We all know that early detection is one of the most important aspects of surviving breast cancer. Yet, many of us or our loved ones delay getting our annual exams due to lack of time and the pressures of life. The breast cancer screening guidelines published by the American Cancer Society were last updated in 2010. The recommendations include:
- Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.
- Clinical breast exam (CBE) about every 3 years for women in their 20’s and 30’s and every year for women 40 and over.
- Women should know how their breasts normally look and feel and report any breast change promptly to their healthcare provider. Breast self-exam (BSE) is an option for women starting in their 20’s.
Raloxifene, an effective alternative
Chemoprevention in the form of Tamoxifen or Raloxifene (Evista) will also be offered to patients with an increased risk of developing breast cancer. An increased risk is determined by a Gail score of 1.66 or greater, or due to a history of lobular carcinoma in situ. Overall, the data from the Breast Cancer Prevention Trial showed a 49 percent reduction in the development of estrogen-positive breast cancer in pre-menopausal and postmenopausal patients who took Tamoxifen for 5 years. However, according to the most recent results of the STAR trial, Raloxifene is just as effective as Tamoxifen in reducing the number estrogen-positive invasive breast cancers in postmenopausal women, but with less toxicity. In addition, Raloxifene was protective against osteoporosis. Furthermore, the STAR trial, one of the largest chemoprevention trials ever, showed that both drugs reduced the incidence of postmenopausal estrogen-positive invasive breast cancer by about 50 percent. Although no drugs are without side effects, Tamoxifen and Raloxifene are viable options for women who are at increased risk of breast cancer and want to be proactive about their health.
story by SOLANGE PENDAS, MD
BIO: Dr. Solange Pendas is a surgical oncologist and Polk County Medical Association member who practices at Lakeland Regional Cancer Center. Dr. Pendas is board certified in general surgery and speaks fluent English and Spanish. One of the many awards she has received has been the Gold Medal Paper: Southeastern Surgical Congress, February 1999 for Sentinel Node Biopsy and Cytokeratin Staining for the Accurate Staging of 478 Breast Cancer Patients. The American Surgeon, Vol. 65, No. 6, June 1999.