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Breast cancer

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of breast cancer.

Alternative Names

Mammograms; Mastectomy

Highlights

Screening

Women at high risk for breast cancer should have an MRI scan along with their annual mammogram, according to new guidelines from the American Cancer Society.

Guidelines from the American College of Physicians recommend women with a low risk for breast cancer talk to their doctor before starting to have mammogram screening at age 40.

Tamoxifen and Raloxifene for Prevention

• Raloxifene (Evista) works as well as tamoxifen (Nolvadex) in reducing the risk of invasive breast cancer in women with BRCA gene mutations, indicates an important study in the Journal of the American Medical Association ( JAMA ).
• Raloxifene may pose less risk for blood clots than tamoxifen, suggests the JAMA study. However, a New England Journal of Medicine ( NEJM ) study notes that raloxifene still produces a small increase in the risk for blood clots and stroke.
• These drugs may not be safe for women with pre-existing heart problems. In any case, only women at high risk for inherited types of breast cancer should consider taking these drugs for prevention.

Trastuzumab

• Trastuzumab (Herceptin) has emerged as an important treatment for women with HER2-positive breast cancer, a particularly aggressive type of cancer. Several NEJM studies report that trastuzumab given along with or after adjuvant chemotherapy significantly improves survival and prevents cancer recurrence.
• Trastuzumab can cause heart failure and other heart problems, especially for women with pre-existing heart conditions. Patients who take this drug need to have regular heart check-ups.

Aromatase Inhibitors

Aromatase inhibitors may be better than tamoxifen in improving survival and preventing recurrence in postmenopausal women with estrogen-sensitive breast cancers. These drugs are less likely to cause blood clots than tamoxifen, but may be more likely to cause osteoporosis, the “thin bone” condition that can lead to bone fractures.

Hormone Replacement Therapy (HRT)

• Long-term combination (progestin and estrogen) HRT increases the risk for breast cancer. New research indicates that women who use estrogen-alone HRT for 10 years or more also have an increased risk. Combined estrogen and testosterone doubles breast cancer risk.
• Short-term (less than 3 years) HRT is safe for high-risk women who have had their ovaries removed.

Obesity

Women who gain weight after menopause increase their risk of developing breast cancer. Losing weight after menopause can reduce risk.

• Review Date: 4/3/2007
• Reviewed By: Editorial Team: Greg Juhn, M.T.P.W., David R. Eltz, Kelli A. Stacy. Previously reviewed by Harvey Simon, M.D., Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital (10/2/2006).

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