Preventive Treatment

WHAT SHOULD I DO IF I HAVE HIGH RISKS? 


Breast cancer patients are often categorised according to their lifetime risk. For example, female mutation carriers of the BRCA1 and BRCA2 genes have up to a 90 percent lifetime risk for developing breast cancer. If you are a patient at high risk, depending on your risk assessment or breast cancer diagnosis, your oncologist will plan for you the according preventive measures and medical interventions needed.

If you are at greater than normal risk for developing breast cancer, consider:

• Tamoxifen. It is a chemotherapy agent that interferes with the cancer process. Tamoxifen is used to reduce the incidence of breast cancer in women with high risk. Certain breast cancers are made up of cells that react to the hormone oestrogen which can stimulate the cells to multiply. These types of cancers are called oestrogen receptor–positive breast cancers. Tamoxifen works by blocking the action of oestrogen. Your oncologist would explain this to you upon prescription, along with how the risk of developing this type of breast cancer is only reduced and not cut down completely. However, tamoxifen use for breast cancer risk reduction is associated with an increased incidence of uterine or endometrial cancers. Also, serious and life-threatening events, including stroke and pulmonary emboli may also occur in patients taking tamoxifen. Tamoxifen is still being studied in a large cooperative national study group to determine if it can effectively prevent breast cancer in women at high risk. Tamoxifen costs about 100$ per month in the United States. In Malaysia, it is roughly RM200 for a box of 100 tablets of 20mg of Tamoxifen Citrate.*

• Raloxifene is an agent effective in preventing breast cancer which acts similar to Tamoxifen. Many of the side effects of raloxifene are the same as tamoxifen. Raloxifene has only been tested in postmenopausal women (when menstruation stops) and is therefore only available to women who have reached their menopause.

• Prophylactic mastectomy is a preventive surgery to remove one or both breasts in order to reduce the risk of breast cancer. This can be a very difficult decision for patients to make. The effect of prophylactic mastectomy is that it severely decreases the long-term quality of life, and this has a large impact on patients. However, prophylactic mastectomy greatly reduces patient’s risk for breast cancer and its recurrence. It also increases the patient’s survival rate.

• Oopherectomy is a surgery which removes either one or both ovaries. Patients with the inherited BRCA1 and BRCA2 mutations are recommended to undergo an oopherectomy because these patients have a higher risk of developing ovarian cancer and breast cancer. Hence, if you have undergone genetic testing and are known to carry the inherited BRCA mutations, prophylactic oophorectomy is a good prevention option.

*All prices stated are rough estimates and may or may not apply to your local health care institutes. 


References:
1) Dixon J.M. 2006. ABC of Breast Diseases (3rd Edition). Oxford: BMJ Publishing.
2) Clark M.L. Kumar P. 2005. Kumar and Clark's Clinical Medicine (6th Edition). Edinburgh: Elsevier Saunders.