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Breast Cancer prevention

This page presents information on the prevention of breast cancer, including screening, lifestyle, surgery, and breast cancer prevention trials.

Breast cancer prevention - Breast Screening

Women aged 50-70 years are offered the opportunity of early detection of breast cancer through the NHS Screening Programme1

Breast cancer prevention - Lifestyle

Avoiding alcohol and exogenous hormones including oral contraceptives and hormone replacement therapy (HRT) would lower risk further, but these factors have effects beyond the breast and their risks and benefits may need to be assessed individually.

Because each of the risk factors has an independent effect on risk, the higher a woman's background risk, for example, the older she is, the more important her increase in risk is in absolute terms.

Breast cancer prevention - Surgery

Women at very high risk (for example BRCA1/ mutation carriers) can consider prophylactic surgery which reduces risk by approximately 90%. 3

Breast cancer prevention - Trials

Changes in patterns of reproduction in westernised countries, for example, having more children and doing so earlier in life, are not practicable and therefore many trials are looking at the possibility of reducing exposure to oestrogen through chemoprevention.4

Breast cancer prevention trials show that taking tamoxifen reduces the risk of oestrogen receptor (ER) positive breast cancer by 30-40% 5-7 but side-effects include increased risk of endometrial cancer and thromboembolic events. A number of alternative strategies are being tested to reduce the side-effects of tamoxifen, for example, lowering the dose oftamoxifen8, concomitant use of low-dose aspirin, and using alternative selective oestrogenreceptor modulators.9

Other trials are investigating aromatase inhibitors 10 such as anastrozole, which appears to be better tolerated than tamoxifen and does not increase the risk of endometrial cancer and thromboembolism. However, there is a suggestion that it may increase the risk of osteoporosis and bone-fracture rate.

The IBIS-2 trial, which is currently recruiting, will investigate anastrozole versus a placebo in high risk postmenopausal women. Another group of substances under investigation are luteinising-hormone releasing hormones (LHRH). 11

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References

1. Salih, A.K. and Fentiman, I.S., Breast cancer prevention: present and future. Cancer Treat Rev, 2001. 27(5): p. 261-73.
2. Department of Health, Infant Feeding Survey 2000. 2002, London: TSO.
3. Hartmann, L.C., et al., Efficacy of bilateral prophylactic mastectomy in BRCA1 and BRCA2 gene mutation carriers. J Natl Cancer Inst, 2001. 93(21): p. 1633-7.
4. Clamp, A., Danson, S., and Clemons, M., Hormonal risk factors for breast cancer: identification, chemoprevention, and other intervention strategies. The Lancet Oncology, 2002. 3(10): p. 611-619.
5. Fisher, B., 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(18): p. 1371-88.
6. Cuzick, J., et al., First results from the International Breast Cancer Intervention Study (IBIS-I): a randomised prevention trial. Lancet, 2002. 360(9336): p. 817-24.
7. Cuzick, J., et al., Overview of the main outcomes in breast-cancer prevention trials. Lancet, 2003. 361(9354): p. 296-300.
8. Wu, K. and Brown, P., Is low-dose tamoxifen useful for the treatment and prevention of breast cancer? J Natl Cancer Inst, 2003. 95(11): p. 766-7.
9. STAR trial
10. Smith, I.E. and Dowsett, M., Aromatase inhibitors in breast cancer. N Engl J Med, 2003. 348(24): p. 2431-42.
11. Clamp, A., Danson, S., and Clemons, M.,Hormonal risk factors for breast cancer: identification, chemoprevention, and other intervention strategies. Lancet Oncol, 2002. 3(10): p. 611-9.

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