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Many of the factors that influence your chances of developing breast
cancer--your age or inheritance of a breast cancer susceptibility
gene--are beyond your control. Others present opportunities for change,
and several large research studies are looking at possibilities for
intervention--changing medication, diet, or behavior to prevent or delay
onset of disease.
The Breast Cancer Prevention Trial is a randomized study of tamoxifen,
a drug that has been widely used in the treatment of women with breast
cancer. Because tamoxifen, when taken for 5 years, has been found to markedly
reduce the occurrence of new cancers in the opposite breast of a woman
who has already had breast cancer, it is now being tried as a prevention
treatment in healthy women at increased risk for breast cancer either
because they are age 60 or older, or because they are between the ages
of 30 and 59 and have combinations of high-risk factors.
Nutrient chemoprevention
is being tested in research studies in Italy, where women who have already
been treated for breast cancer are taking 4-HPR, a synthetic form of vitamin
A, in hopes of preventing cancer in the opposite breast. Other researchers
are investigating the protective potential of several other vitamins,
including C and E. Yet other scientists are checking out naturally occurring
chemicals, called phytochemicals,
found in common fruits, vegetables, and other edible plants, in hopes
of finding cancer-fighting substances that can be extracted, purified,
and added to our diets.
Diet itself is another target of prevention research. In the Women's
Health Initiative, a project of the National Institutes of Health, 70,000
women over age 50 are enrolled in a series of clinical studies to measure
the effectiveness of prevention strategies for coronary heart disease,
cancer, and osteoporosis.
Strategies under study include a low-fat diet (less than 20 percent of
calories from fat) and calcium plus vitamin D supplements, along with
hormone replacement therapy.
Another large study evaluating a low-fat diet in high-risk women is under
way in Canada.
A much more drastic approach to breast cancer prevention is surgery to
remove both breasts. Such a procedure, known as prophylactic
mastectomy, is sometimes chosen by women with a very high risk
for breast cancer--for instance, carrying a genetic mutation in BRCA1
or BRCA2, having a mother and one or more sisters with premenopausal breast
cancer, plus a diagnosis of atypical hyperplasia and a history of several
breast biopsies.
Unless a woman finds that anxiety is undermining the quality of her
life, she is usually counseled not to choose this physically and
psychologically draining surgery. The vast majority of breasts removed
prophylactically show no signs of cancer. Moreover, since even a total
mastectomy can leave a small amount of breast tissue behind, it cannot
guarantee the woman will remain cancer-free. The preferred approach for
most high-risk women is careful watching with clinical breast exams and
mammography once or twice a year.
If you are considering a prophylactic mastectomy, with or without
subsequent breast reconstruction, you will want to get a second opinion,
preferably from a breast specialist. There is seldom reason to rush your
decision. Many doctors advise a woman to give herself several months to
weigh the options.
If your risk for breast cancer is high, you might also consider
talking with a genetic counselor about gene testing for breast cancer
susceptibility. (See Gene Testing, page 18.)
Whether your risk of breast cancer is average
or higher, there are some steps you can take:
- Follow early detection practices. Ask your doctor when you should
begin mammograms at regular intervals. Get regular breast exams by a
doctor or nurse.
- Consult your doctor about your personal situation and carefully
weigh any potential risks against the benefits in making decisions
about hormone-containing drugs. Stay informed as new research
findings become available.
- Exercise and eat a balanced diet that provides a good variety of
nutrients and plenty of fiber. Limit dietary fat and alcohol. These
are good health measures that make sense for everyone.
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