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Prevention of Breast Cancer (includes chemoprophylaxis for breast cancer)

see Prevention Indications: Benefit/risk: - 22 high-risk women needed to be treated with tamoxifen for 5 years to prevent 1 breast cancer over 20 years [7] Management: - avoidance of weight gain in adulthood - limiting the consumption of alcohol [1] - Mediterranean diet supplemented with extra-virgin olive oil may have a beneficial effect in the primary prevention of breast cancer [8,11] - high fiber diet during adolescence may diminish risk of breast cancer [12] (RR= 0.86-0.87) - aspirin use associated with reduced risk of breast cancer [3] a) odds ratio 0.8 for weekly use; 0.72 for daily use b) aspirin use associated with diminished mortality in women diagnosed with breast cancer [4] b) ibuprofen associated with reduced risk of breast cancer but association weaker than that for aspirin - caffeine consumption associated with reduced risk in women with BRCA1 or BRCA2 mutations - mushrooms, especially in combination with green tea reduces risk in Chinese women [2] - bisphosphonate use associated with diminished risk (30%) [5] - tamoxifen*, raloxifene* & exemestane* can lower risk for estrogen receptor-positive breast cancer in high-risk postmenopausal women [6] - associated risk 7.0% vs 9.8% with tamoxifen over 16 years [7] - increased mortality with tamoxifen not statistically significant === Chemoprophylaxis for breast cancer === - Indications: - women with elevated 5-year risk of breast cancer - lobular carcinoma in situ - atypical hyperplasia - tamoxifen & raloxifene should not be used to lower risk for primary breast cancer in women not at increased risk [6] - exemestane reduces risk of breast cancer in post-menopausal women with atypical ductal hyperplasia [9,10] - anastrozole 1 mg PO QD for 5 years reduces long-term risk of breast cancer in high-risk women [15] - tamoxifen & aromatase inhibitors may reduce risk of subsequent breast cancer in estrogen receptor positive DCIS (either side) but does not confer survival benefit [9] - USPSTF recommends aromatase inhibitors to reduce risk of breast cancer in high risk women [13] * tamoxifen also useful for prevention of estrogen receptor-positive breast cancer in premenopausal women * raloxifene not studied in premenopausal women * both tamoxifen & raloxifene contraindicated in women with prior thromboembolic event * exemestane not associated with increased risk for vascular events, cardiac disease, endometrial cancer, osteoporosis or fractures within a 3-year follow-up period [9] === Surgical prophylaxis for breast cancer === - offer prophylactic bilateral mastectomy & bilateral salpingo- oophorectomy to BRCA1/BRCA2 gene mutation positive women [13] - salpingo-oophorectomy at age 35-40 BRCA1 mutation, age 40-45 BRCA2 mutation [13]

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breast cancer chemoprophylaxis for breast cancer

General

prophylaxis (prevention, ppx)

References

  1. Michels KB et al Diet and breast cancer: a review of the prospective observational studies. Cancer. 2007 Jun 15;109(12 Suppl):2712-49. Review. PMID: 17503428
  2. Zhang M et al Dietary intakes of mushrooms and green tea combine to reduce the risk of breast cancer in Chinese women. Int J Cancer 2009 Mar 15; 124:1404. PMID: 19048616
  3. Terry MB, Gammon MD, Zhang FF, Tawfik H, Teitelbaum SL, Britton JA, Subbaramaiah K, Dannenberg AJ, Neugut AI. Association of frequency and duration of aspirin use and hormone receptor status with breast cancer risk. JAMA. 2004 May 26;291(20):2433-40. PMID: 15161893
  4. Holmes MD et al Aspirin intake and survival after breast cancer. J Clin Oncol 2010, 29: PMID: 20159825 http://jco.ascopubs.org/cgi/reprint/JCO.2009.22.7918v1
  5. Cardwell CR et al Exposure to oral bisphosphonates and risk of cancer. Int J Cancer. 2011 Dec 8. doi: 10.1002/ijc.27389 PMID: 22161552 - Monsees GM et al Bisphosphonate use after estrogen receptor-positive breas cancer and risk of contralateral breast cancer. J Natl Cancer Inst. 2011 Dec 7;103(23):1752-60. Epub 2011 Oct 21. PMID: 22021667 - Chlebowski RT. Bisphosphonates and breast cancer incidence and recurrence. Breast Dis. 2011 Dec 5. [Epub ahead of print] PMID: 22142660
  6. Moyer VA et al Medications for Risk Reduction of Primary Breast Cancer in Women: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. Published online 24 September 2013 PMID: 24061472 http://annals.org/article.aspx?articleid=1740758
  7. Cuzick J et al Tamoxifen for prevention of breast cancer: extended long-term follow-up of the IBIS-I breast cancer prevention trial. The Lancet Oncology, Early Online Publication, 11 December 2014 PMID: 25497694 http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2814%2971171-4/fulltext - Chlebowski RT IBIS-I tamoxifen update: maturity brings questions. The Lancet Oncology, Early Online Publication, 11 December 2014 PMID: 25497695 http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2814%2971184-2/fulltext
  8. Toledo E et al Mediterranean Diet and Invasive Breast Cancer Risk Among Women at High Cardiovascular Risk in the PREDIMED TrialA Randomized Clinical Trial. JAMA Intern Med. Published online September 14, 2015. PMID: 26365989 http://archinte.jamanetwork.com/article.aspx?articleID=2434738 - Katz MH Can Diet Prevent Breast Cancer? JAMA Intern Med. Published online September 14, 2015. PMID: 26365829 http://archinte.jamanetwork.com/article.aspx?articleID=2434734
  9. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19. American College of Physicians, Philadelphia 2015, 2018, 2021.
  10. Goss PE et al Exemestane for Breast-Cancer Prevention in Postmenopausal Women N Engl J Med. 2011 Jun 23;364(25):2381-91. Epub 2011 Jun 4. PMID: 21639806
  11. Slomski A Mediterranean Diet With Olive Oil May Reduce Breast Cancer Risk. JAMA. 2015;314(20):2122. PMID: 26599177 http://jama.jamanetwork.com/article.aspx?articleID=2471568
  12. Young K, Sadoughi S, Sofair A Higher Fiber Intake in Adolescence Linked to Lower Risk for Breast Cancer. Physician's First Watch, Feb 1, 2016 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Farvid MS et al Dietary Fiber Intake in Young Adults and Breast Cancer Risk. Pediatrics. 2016 Feb 1. PMID: 26908709 http://pediatrics.aappublications.org/content/early/2016/01/28/peds.2015-1226
  13. American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 182 Summary: Hereditary Breast and Ovarian Cancer Syndrome. Obstetrics & Gynecology. 130(3):657-659, SEP 2017 PMID: 28832475 https://insights.ovid.com/crossref?an=00006250-201709000-00035
  14. US Preventive Services Task Force Recommendation Statement Medication Use to Reduce Risk of Breast Cancer. US Preventive Services Task Force Recommendation Statement. JAMA. 2019;322(9):857-867. September 3, 2019 PMID: 31479144 https://jamanetwork.com/journals/jama/fullarticle/2749221 - Nelson HD, Fu R, Zakher B et al Medication Use for the Risk Reduction of Primary Breast Cancer in Women. Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2019;322(9):868-886. September 3, 2019 PMID: 31479143 https://jamanetwork.com/journals/jama/fullarticle/2749220 - Pace LE, Keating NL. Medications to reduce breast cancer risk: Promise and limitations. JAMA 2019 Sep 3; 322:821 PMID: 31479121 https://jamanetwork.com/journals/jama/article-abstract/2749196
  15. Cuzick J, Sestak I, Forbes JF et al Use of anastrozole for breast cancer prevention (IBIS-II): long-term results of a randomised controlled trial. Lancet. Dec 12, 2019 PMID: 31839281 Free Article https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32955-1/fulltext