Women with a strong family history of breast cancer and women who carry the BRCA1 and BRCA2 genes have an elevated risk of developing breast cancer and may decide to take more aggressive preventive measures, such as the use of anti-estrogen therapy, prophylactic (preventive) bilateral mastectomy, and/or prophylactic oophorectomy.
Chemoprevention: Drugs that inhibit the effects of estrogen have been shown to reduce the risk of breast cancer in women at high risk of the disease. Two drugs that have been approved for breast cancer risk reduction in certain groups of women are tamoxifen and Evista® (raloxifene). Tamoxifen is approved for breast cancer risk reduction in women who are at high risk of the disease (including high-risk premenopausal women). Evista – originally approved for the prevention and treatment of osteoporosis—is approved for breast cancer risk reduction in postmenopausal women with osteoporosis or postmenopausal women at high risk of breast cancer.
Bilateral Prophylactic Mastectomy (preventive removal of both breasts): Women at high risk of breast cancer may reduce their risk of developing breast cancer by 90% by undergoing bilateral prophylactic mastectomy. Prophylactic mastectomy may decrease concerns about developing breast cancer, but may increase concerns related to self-esteem, sexuality, and femininity. Women considering this procedure need to carefully weight the potential risks and benefits.
Prophylactic Oophorectomy (preventive removal of the ovaries): The BRCA1 and BRCA2 genes increase the risk of both breast and ovarian cancer. Removal of the ovaries before cancer develops reduces the risk of ovarian cancer by about 96 percent. Surgery doesn’t completely eliminate risk because some cells remain behind after surgery. Removal of the ovaries also reduces the risk of breast cancer since some breast cancers don’t grow well without the hormones produced by the ovaries. Women with a BRCA1 or BRCA2 alteration who have had their ovaries removed have about half the risk of developing breast cancer as those who have not had their ovaries removed. Adverse effects of prophylactic oophorectomy include the inability to have children and the development of menopausal symptoms such as hot flashes.
For several types of cancer, progress in the area of cancer screening has led to earlier cancer detection and better outcomes. The term screening refers to the regular use of certain examinations or tests in persons who do not have any symptoms of a cancer but are at high risk for that cancer.
Mammography: A mammogram is an x-ray image of the breast that can reveal irregularities and help to detect cancer early when it is most treatable. For women at average risk of breast cancer, the U.S. Preventive Services Tasks Force (USPSTF) recommends screening mammography every two years starting at the age of 50. The American Cancer Society, in contrast, continues to recommend annual mammograms starting at the age of 40 for women at average risk. Women who have questions about the screening approach that’s right for them are advised to talk with their doctor. Women at high risk of breast cancer may need to begin screening at an early age.
Clinical Breast Exam: Regular physical examination plays an important role in the health maintenance. An annual gynecological examination is an important screening procedure for several types of cancer and includes a physical examination of the breasts. During this procedure, a healthcare provider physically examines the breasts to feel for any lumps or irregularities.
Magnetic Resonance Imaging (MRI): MRI uses radio waves and a magnet to create detailed images of the inside of the body. The American Cancer Society recommends that women at high risk of breast cancer undergo yearly breast cancer screening with breast MRI in addition to mammography. These recommendations were prompted by several studies of MRI screening of women at high risk of breast cancer. While these studies found that the addition of MRI to mammography increased the frequency of false-positive test results compared with mammography alone, it also produced important improvements in breast cancer detection.
Predictive Genetic Testing: The identification of the breast cancer susceptibility genes BRCA1 and BRCA2 has led to predictive genetic testing for these genes. Since most breast cancers are not due to known inherited mutations, not all women are candidates for genetic testing. Women who appear to be at a high risk, however, may wish to consider being tested for BRCA1 or BRCA2 gene mutations. An accurate genetic test can reveal a genetic mutation, but cannot guarantee that cancer will or will not develop. At this point, genetic tests are used to identify individuals who are at an increased risk of developing cancer, so that these individuals may have the option of taking preventive measures. For more information about genetic testing, please refer to the section Genetic Testing.
Patients who have already undergone surgery and lymph node evaluation and know their stage of cancer may select from the options below. In order to learn more about surgery and sentinel lymph node dissection, go to Surgery for Breast Cancer.
Carcinoma In Situ: Noninvasive (Stage 0) disease. This may be ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS).
Stage I: Cancer that is confined to the breast and measures less than 2 cm (about 3/4 inch).
Stage II : Cancer that is less than 5 cm (2 inches) in size and involves axillary lymph nodes, or is greater than 2 cm (3/4 inch) and does not involve axillary lymph nodes.
Stage III: Cancer that involves both a large tumor size and lymph node involvement; more extensive lymph node involvement (such as fixed or matted lymph nodes); or a primary cancer that is attached to the chest wall or skin.
Inflammatory: A rare but aggressive type of breast cancer that may cause the breast to be swollen, red, and warm. The breast may also have a pitted appearance, similar to the skin of an orange.
Stage IV: Cancer that has spread to distant sites in the body.
Recurrent/Relapsed: The breast cancer has progressed or returned after initial treatment.