An article published in The Cancer Journal for Clinicians, Wednesday, states that half of breast cancers in the U.S. might be avoided if women adopted healthier lifestyles sooner in life, and the highest-risk women took preventive drugs like tamoxifen.
The article reviews breast cancer primary prevention strategies that are applicable to all women, discusses the underutilization of chemoprevention in high-risk women, highlights the additional advances that could be made by including young women in prevention efforts.
"This article is re-stating many things we have known for some time regarding breast cancer prevention," said Dr. Robert Goulet, breast surgeon and MD Anderson certified physician with Community Physician Network. "However, I agree that we don’t place enough emphasis on preventive strategies at all ages."
Goulet states that there are simple lifestyle modifications that women should make to decrease their risk.
"There is irrefutable evidence that, through study of women over decades, as little as 30 minutes of vigorous exercise three times a week leads to significant reduction in breast cancer risk," he said. "Weight control has also been implicated, and I think that goes hand in hand with exercise strategy."
A healthy diet with emphasis on trying to minimize weight gain is also incredibly important, and that includes a decrease in alcohol consumption.
"There are recent studies that clearly demonstrate that women who drink as little as one ounce of alcohol at least three times a week have an increased risk of developing breast cancer," said Goulet. "The impact of exposure to carcinogens such as alcohol begin at we believe a very early age. So recognition of the fact that you have the ability to change risk has to occur at a younger age."
With respect to drugs such as tamoxifen and raloxifene, Goulet states that there is a fair amount of controversy regarding the use of those drugs.
"This approach to minimize risk of breast cancer is known as chemoprevention," said Goulet. "What we do is give the patients a medication which blocks the effect of estrogen."
There are several issues related to the administering of chemoprevention medication, including patient compliance and risk.
Goulet said, "By giving a woman raloxifene or tamoxifen, you make them feel menopausal – they have hot flashes and some complain of weight gain."
Additionally, raloxifene and tamoxifen are not completely non-toxic medications. There is an increased risk of pulmonary embolism, blood clots in the lungs, and an increased risk of stroke. There also is a small but significant increase in risk of uterine cancer, particularly in the case of tamoxifen.
"The application of these drugs have to be very carefully considered – again, compliance and the side effects of medication being taken into consideration," said Goulet. "At Community, only select patients with very specific indications are going to subscribe to the chemo-preventive approach. It’s not for everybody, and even for those who might benefit from the approach, they need to understand what they are embarking on when they start the medication."
Through early prevention and lifestyle modifications women can significantly decrease their breast cancer risk.
"The message here is that you can’t wait until you are 45 or 50 to take notice of cancer risk factors," said Goulet.
Breast cancer prevention
For more information on how to prevent breast cancer, or to schedule a mammogram screening, visit our breast care website.