Many of the factors that influence
your chances of developing breast cancer-your age, a family history
of breast cancer, the age at which you began to menstruate-are
beyond your control. Others, however, present opportunities for
change, and several large research trials are looking at
possibilities for "intervention."
The Breast Cancer Prevention Trial is a randomized study of
a drug that has been widely used in the treatment
of women with breast cancer. Because tamoxifen has been found to
markedly reduce the occurrence of new cancers in the opposite
breast of women who have already had breast cancer, it is now being
tried as a preventive in healthy women at increased risk for breast
cancer because they are 60 or older or are younger but have
combinations of other risk factors. (Tamoxifen also appears to
offer protection against heart attacks and osteoporosis.)
is being tested in Italy, where
women who have already been treated for breast cancer are taking
4-HPR, a synthetic form of vitamin A, in hopes of preventing cancer
from developing in the opposite breast. Other researchers are
investigating the protective potential of several other vitamins,
including C and E as well as beta-carotene, the form of vitamin A
found in fruits and vegetables. Yet other scientists are checking
out naturally occurring chemicals, called phytochemicals, found in
common fruits, vegetables, and other edible plants, in hopes of
finding cancer-fighting substances that can be extracted, purified,
and added to our diets.
Diet itself is another target of prevention research. In the
Women's Health Initiative, a project of the National Institutes of
Health, 70,000 women over 50 are being enrolled in a series of
clinical trials to measure the effectiveness of a low-fat diet
(less than 20 percent of calories from fat) and calcium plus
vitamin D supplements, along with hormone replacement therapy, in
combatting heart disease and osteoporosis as well as cancer.
Another large trial evaluating a low-fat diet in high-risk women is
under way in Canada.
A much more drastic approach to breast cancer prevention is
surgery to remove both breasts. Such a procedure, known as
is sometimes chosen by women with a
very high risk for breast cancer-for instance, having a mother and
one or more sisters with bilateral premenopausal breast cancer,
plus a diagnosis of atypical hyperplasia and a history of several
Unless a woman finds that anxiety is undermining the quality of
her life, she is usually counseled not to choose this physically
and psychologically draining surgery. The vast majority of breasts
removed prophylactically show no signs of cancer. Moreover, since
even an ordinary ("total") mastectomy can leave a small amount of
breast tissue behind, it cannot guarantee the woman will remain
cancer-free. The preferred approach for most high-risk women is
careful surveillance with clinical breast exams and mammography
once or twice a year. Also, monthly breast self-examinations are
If you are considering a prophylactic mastectomy, with or
without subsequent breast reconstruction, you will want to get a
second opinion, preferably from a breast specialist. There is
seldom reason to rush your decision. Many doctors advise a woman to
give herself several months to weigh the options.
Whether your risk of breast cancer is low or high,
there are some preventive steps you can take:
You can follow early detection practices. Request
mammograms-every 1-2 years if you are age 40 or older, and every
year if age 50 or older; get yearly breast exams by a doctor or
nurse; and perform monthly breast self-exams.
If your risk is elevated, you can enroll in one of the
prevention trials; for information, call the Cancer Information
Service at 1-800-4-CANCER.
In making decisions about hormone-containing drugs, you can
consult your doctor about your personal situation and carefully
weigh any potential risks against the benefits. You can stay
informed as new research findings become available.
You can lose excess weight, eat a balanced diet that provides a
good variety of nutrients and plenty of fiber, limit dietary fat,
and drink alcohol only in moderation. These are "good health"
measures that make sense for everyone.