Breast Cancer Increased Risk, Genetics and Prevention

Lobular carcinoma in situ is not a cancer, but rather a marker for an increased risk for developing breast cancer. Patients with LCIS have an approximately nine-fold increase in their risk for developing breast cancer. In other studies it has been cited to confer a 20 percent risk of developing breast cancer in the 20 years after diagnosis, a one percent per year risk.

Family history can significantly increase the risk of breast cancer. About 30 percent of women may have a family history of breast cancer, but only about 10 percent of women have a strong inherited risk for breast cancer. Genetic testing can be performed to determine your individual risk. Our genetic counselors offer a complete evaluation of family history and other factors that may increase the risk of developing breast, ovarian and other cancers.

Several genes, including BRCA1 and BRCA2, have been found to have mutations that can significantly increase the risk of developing breast, ovarian and other cancers. 

Genetic testing or counseling for breast and related cancers may be indicated if:

• You or a close relative have the same or related cancer (i.e. breast and ovarian)
• You or a close relative have had breast cancer before age 50
• You or a close relative have been diagnosed with more than one type of cancer (i.e. breast, ovarian, colon, uterine)
• You are of Eastern European Jewish ancestry with a family history of breast or ovarian cancer
• You have a family history of any rare cancer or multiple different cancers 
• You a have family history of male breast cancer
• A close relative is known to have a genetic mutation that can increase the risk of cancer.

Every woman has a baseline risk for developing breast cancer. This is different for every individual, and is dependent on a number of factors, many of which a person has no control over, such as genetic predisposition.

However, there are measures that an individual can take that will minimize their risk within the framework of their background predisposition. The most effective ways to prevent breast cancer are simple changes that anyone can make. Making positive lifestyle choices by maintaining a healthy weight, exercising and avoiding behaviors known to cause cancer (smoking, more than moderate alcohol consumption) are recommended to decrease one’s risk.

Performing monthly breast self-exams, getting yearly mammograms starting at the age of 40, and seeing your doctor on a regular basis for clinical breast exams are all recommended by the doctors of The Hoffberger Breast Center.

For women who are at an increased risk of developing breast cancer there are medications that reduce the risk for developing breast cancer – Tamoxifen and Raloxifene (Evista™). Women at the greatest risk may be candidates for a bilateral preventive mastectomy.

Tamoxifen and Raloxifene to Prevent Breast Cancer
Studies have found that women taking Tamoxifen to prevent breast cancer have a reduced risk for at least several years after their treatment ends, according to two studies in the Journal of the National Cancer Institute.  Follow-up of women on the STAR trial (Study of Tamoxifen and Raloxifene) for breast cancer prevention showed persistent benefit after completing the 5 years of treatment, but the long term benefit was stronger for Tamoxifen compared to Raloxifene. 

Tamoxifen may be used for both premenopausal and postmenopausal women. Raloxifene is approved only for use among postmenopausal women for breast cancer risk reduction.  Raloxifene’s safety profile is better than Tamoxifen, especially if women still have their uterus, since the increased risk of uterine cancer seen with Tamoxifen is not reported with Raloxifene. 

Women should have their risk of breast cancer assessed and then discuss with their health care provider to decide if taking Tamoxifen or Raloxifene is appropriate for them.