PREVENTING BREAST CANCER Roblee 1

Preventing Breast Cancer

Mya Roblee

September 26, 2017

Academy for Arts, Science and Technology

PREVENTING BREAST CANCER Roblee 2

Introduction

With the growing occurrence of Breast Cancer, many solutions have been studied, such

as surgery, chemoprevention, and hormone therapy, to avoid and treat the disease. High-risk

patients should look into these prevention options; breast cancer is not worth the wait. Someone

who is concerned about developing breast cancer can help self-prevent by eating healthy,

exercising and maintaining weight, not smoking, limiting alcohol consumption, and breast-

feeding. Surgery is considered the best option for it involves removing some of, or all of, one or

both breasts. Although surgery is the best option, all prevention strategies should be considered

by high-risk patients to get the best treatment plan possible for them to avoid the growth of

breast cancer.

Research

Prophylactic, or preventative, mastectomy is the best possible solution for high-risk patients for

breast cancer to choose for the prevention of breast cancer. A mastectomy is an operation that

aims to remove all breast tissue that could possibly develop into breast cancer. Preventative

mastectomy, bilateral and contralateral, should only be considered for high-risk patients. High-

risk patients include those who have a mutation of the BRCA1 or BRCA2 gene, family history of

the disease, endocrine factors, and host factors such as breast density and a history of benign

breast disorders. Patients who are positive to have one of the BRCA mutations or a family

history of breast cancer, are at the most-high risk and should definitely consider breast surgery.

Bilateral Prophylactic Mastectomy (BPM) has revealed to significantly lower the threat of

developing breast cancer. Bilateral prophylactic mastectomy has been shown to reduce the risk

of breast cancer by at least 95 percent in women who have a deleterious (disease-causing)

mutation in the BRCA1 gene or the BRCA2 gene and by up to 90 percent in women who have a
PREVENTING BREAST CANCER Roblee 3

strong family history of breast cancer (cancer.gov, 2013, p. 1). BPM use is increasing for the

prevention of breast cancer because more high-risk patients are bearing in mind the option for

the surgery. Although it does not completely remove breast cancer risk, studies have shown that

it greatly lowers it. There is also an increasing number of women with unilateral breast cancer

choosing to undergo contralateral prophylactic mastectomy (CPM) to prevent cancer from

developing in the opposite breast. In a 2010 study of 2,504 unilateral breast cancer patients,

1,223 underwent total mastectomy. Of the 1,223, 284 patients underwent contralateral

mastectomy. Increasing numbers of women with breast cancer are electing for contralateral

prophylactic mastectomy (CPM) to reduce the risk of developing contralateral breast cancer (Yi

et al, 2010, pp. 1024-1034). In another study, research had been done into the effectiveness of

CPM on contralateral breast cancer (CPC) patients. Results to this study suggests that CPM has

a positive effect in preventing CPC in patients that already had unilateral breast cancer.

Method: 64 patients undergoing CPM and a control group of 182 patients not undergoing CPM

and matched for age, stage, surgery, chemotherapy, and hormonal therapy were retrospectively

compared for CBC rate, disease-free survival, and overall survival Results: 36 CBCs occurred

in the control group. In the CPM group, 3 CBCs were found at the time of prophylactic

mastectomy, but none occurred subsequently (Peralta et al, 2000, pp. 439-445). Of the group

that underwent CPM, only 5% developed CBC; of the group that did not undergo CPM, 20%

developed CBC.

With the many solutions that have been attempted, hormone therapy is another

preventative strategy used in avoiding breast cancer. Hormone therapy uses hormones for

medical treatment. According to the American Cancer Society, hormone therapy is a type of

systemic therapy, meaning it reaches cancer cells not just in the breast, but also anywhere in the
PREVENTING BREAST CANCER Roblee 4

body. The most common or popular drug used in hormone therapies, for preventing breast

cancer, is Tamoxifen. Tamoxifen is an estrogen-receptor modulator that works by attaching to

the estrogen receptors in breast cells and blocking the effects of the estrogen. In a 2015 study of

the drug, scientists analyzed the results of a clinical trial with 7154 eligible women who are at

risk for breast cancer. The trial separated the women into two groups: 3579 for Tamoxifen and

3575 for placebo, over a 16 year period. Out of 3579 women in the Tamoxifen group, 251

developed breast cancer. In the placebo group, 350 out of 3575 developed breast cancer; about

one-hundred more woman did not develop breast cancer after being exposed to Tamoxifen

(Cuzick et al, 2015, pp. 67-75). The results show that Tamoxifen was successful in preventing

breast cancer. Although Tamoxifen can be an effective prevention plan, it should only be used

for high-risk patients who have not yet gone through menopause. The drug can prevent estrogen-

receptor-positive (ER+) breast cancer, but it cannot prevent estrogen-receptor-positive (ER-)

breast cancer; ER+ breast cancer makes up about 2/3 of all breast cancer cases and ER- breast

cancer makes up the remainder. Tamoxifen is rarely recommended by doctors for it increases the

risk for endometrial cancer.

Before taking any preventative measures against breast cancer, woman who are

susceptible of being high-risk due to family history of breast or ovarian cancer should opt to have

genetic testing done. Genetic testing for breast cancer is used to see if the patient has a mutation

of the BRCA1 or BRCA2 genes, the genes that are linked to the disease. Identification of

BRCA1, the first major susceptibility gene for breast cancer, has provided new leads and sparked

intensive research. Testing for mutated BRCA1 now is the basis for disease risk prediction in

women with a family history of breast cancer. Current study focuses on reliable detection and

interpretation of BRCA1 mutations, and on potential for cancer prevention. The dilemma is that
PREVENTING BREAST CANCER Roblee 5

mutation carriers cannot turn to reliable preventive measures upon being informed of their own

risk. Understanding how the gene functions normally and what processes are affected by

mutation will provide important information on the development and prevention of breast

cancer (Weber, 1996, pp. 12-21). Genetic testing is the best way to assess a woman in knowing

if they are at high-risk for breast cancer or not. Woman who are tested positive for the mutation

are considered high-risk and is suggested that they take preventative measures. Breast cancer is

not always caused by the mutation, but a patient knowing that they have the mutation will help

them to prevent the disease before it possibly develops. Waiting is not an option for any woman

who has the possibility of obtaining breast cancer. This is why breast exams are suggested for

woman, starting at age 20, every 1 to 3 years, and mammograms for woman 40 and older every

year. Woman who believe they are at high-risk should consider getting a breast exam or genetic

testing done. Preventive treatments, such as surgery and hormone therapy, are not suggested to

be taken until the patient is aware of their breast cancer risk.

Conclusion

Preventative strategies were created to prevent the breast cancer before it develops. Out

of these many solutions, prophylactic, or preventative, mastectomy is the best possible solution

for high-risk patients for breast cancer to choose for the prevention of breast cancer. Hormone

therapy drugs like Tamoxifen is another preventive solution, but it does not prevent all breast

cancers specifically ER- breast cancer. The drug also increases the risk for endometrial cancer.

Genetic testing is not a direct solution, but woman should be tested for the BRCA1 or BRCA2

mutations before they take preventative measures to know if they are high-risk. With more

research into exact factors that causes breast cancer, doctors will be able to create specific

preventative plans for patients to get the best treatment possible. Breast cancer is a high-rate
PREVENTING BREAST CANCER Roblee 6

occurring disease and more people need to be aware of what options they have to prevent the

cancer before it possibly develops.

PREVENTING BREAST CANCER Roblee 7

Works Cited

Cancer.gov (2013) Surgery to Reduce the Risk of Breast Cancer. (n.d.). Retrieved August 12,

2013

Cuzick, J., Sestak, I., Cawthorn, S., Hamed, H., Holli, K., Howell, A., ... & IBIS-I Investigators.

(2015). Tamoxifen for prevention of breast cancer: extended long-term follow-up of the IBIS-I

breast cancer prevention trial. The lancet oncology, 16(1), 67-75.

Peralta, E. A., Ellenhorn, J. D., Wagman, L. D., Dagis, A., Andersen, J. S., & Chu, D. Z. (2000).

Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing

mastectomy for breast cancer. The American journal of surgery, 180(6), 439-445.

Weber, B. L. (1996). Genetic testing for breast cancer. Sci Med, 3, 12-21.

Yi, M., Hunt, K. K., Arun, B. K., Bedrosian, I., Barrera, A. G., Do, K. A., ... & Litton, J. (2010).

Factors affecting the decision of breast cancer patients to undergo contralateral prophylactic

mastectomy. Cancer Prevention Research, 3(8), 1026-1034.