Cleveland Clinic Journal of MedicineReducing the Risk of Breast Cancer

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Breast cancer prevention strategies have evolved to incorporate comprehensive risk assessment and personalized interventions. In this 2022 article, the authors outline approaches to identifying high-risk individuals and implementing risk-reduction strategies, with particular attention to genetic predisposition, risk-reducing medications, and lifestyle modifications. The authors present evidence-based recommendations for preventive medication selection and timing, while emphasizing the importance of considering cardiovascular health in treatment decisions.

Key Points:

• Genetic testing criteria have expanded significantly, with recent studies showing 23.8% of patients in obstetrics-gynecology practices meeting testing criteria. Risk-reducing medications show particular efficacy in carriers of pathogenic variants predisposed to estrogen-receptor-positive breast cancers.
• Four FDA-approved medications demonstrate significant risk reduction: tamoxifen (50% reduction), raloxifene (38% reduction), exemestane (65% reduction), and anastrozole (53% reduction). Each medication presents distinct benefits and risks, with selection depending on menopausal status and individual risk factors.
• Women with atypical ductal hyperplasia or atypical lobular hyperplasia face a 30% risk of breast cancer at 25 years of follow-up, while lobular carcinoma in situ carries approximately 2% annual risk. These conditions strongly warrant consideration of preventive medication.
• Risk assessment models have evolved to include multiple factors. The Tyrer-Cuzick and CanRisk models incorporate comprehensive family history and genetic testing results, while the modified Gail model provides accessible 5-year and lifetime risk estimates.
• Obesity significantly impacts breast cancer outcomes, with recent studies showing more than 55% obesity prevalence in Black women. The Women’s Health Initiative Dietary Modification trial demonstrated significant reduction in triple-negative breast cancer cases with a low-fat diet.

“The pillars of breast cancer risk management include enhanced surveillance with contrast-enhanced magnetic resonance imaging (MRI), risk-reducing endocrine therapy, and risk-reducing surgery.”

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