Women Need to Know Their Breast Cancer Risk

Not every woman with breast cancer in her family will be diagnosed with the disease. In fact, only about 10% of all women with breast cancer have a very strong family history.

But with the American Cancer Society (ACS) estimating that some 211,300 women in the United States will be diagnosed with breast cancer in 2003, it’s important for every woman to learn about her breast cancer risk. (See related story for risk factor details.)

What Women Can Do

M. D. Anderson and many other major cancer centers now have high-risk breast cancer clinics that provide risk assessments, genetic counseling and prevention options for women who may be at greater risk of the disease.  

“We offer many different tools here that can help a woman refine her risk level and decide which intervention she should consider,” says Banu Arun, M.D., assistant professor in the M. D. Anderson Department of Breast Medical Oncology. One promising new tool is called ductal lavage.

Screening Guidelines

Clinic screening for high-risk women includes:

• Yearly mammogram  
• Monthly breast self-exam 
• Clinical breast exam every 6 to 12 months

Risk Reduction with Tamoxifen

Tamoxifen is a drug that has been shown to reduce the risk of developing breast cancer in high-risk women. But Arun emphasizes that it might not be appropriate for all high risk women given its side effects, as outlined below.

The decision to take tamoxifen is a carefully thought out process; women should complete a thorough risk assessment and counseling with physicians and, if indicated, with genetic counselors. Counseling helps women to determine if the benefits will outweigh the risks, based on each person’s own particular breast cancer risk level.

Side effects associated with Tamoxifen include:

• Hot flashes 
• Blood clot formation (especially in women above the age 50 years)
• Endometrial cancer (especially in women above the age 50 years)

“Knowing her actual risk for developing breast cancer may help a healthy woman decide whether or not to take Tamoxifen,” Arun says.

Early Detection and Prevention Programs

A unique aspect of the M. D. Anderson clinic is its emphasis and study on early detection, education and preventive strategies.
Clinic staff members conduct outreach programs to educate primary care physicians and gynecologists about breast cancer risks, risk reduction, prevention options and identification of at-risk patients.

Within the next six months, they hope to have an MRI screening study for genetically high-risk women.

One clinical study is looking at the effectiveness of Celebrex as a possible preventive drug for breast cancer. Celebrex is widely prescribed to treat arthritis. Its potential use against cancer is now also being investigated.

In previous M. D. Anderson research, scientists found that Celebrex reduced development of precancerous intestinal polyps in patients with a rare, inherited form of colon cancer. This led to a nationwide study to test whether Celebrex and its sister drug Vioxx could prevent colon cancer development. M. D. Anderson is also testing Celebrex to see if it can stave off lung cancer and if it can be used to treat and prevent actinic keratoses (skin lesions resulting from chronic sun exposure that may develop into squamous cell carcinomas).

Women can refer themselves to the clinic if they suspect they may be at high risk of breast cancer. Their local primary care physician, M. D. Anderson physician or the M. D. Anderson Cancer Prevention Center can also refer them.

Multidisciplinary Staff

Staff of the M. D. Anderson high-risk clinic includes physicians, genetic counselors and nurses. Staff members work closely with staff from other M. D. Anderson high-risk clinics such as the cancer center’s ovarian cancer screening clinic because of the link between ovarian and breast cancer. “The beauty of our clinic is that we are a multidisciplinary group, which makes it more convenient for the patient and allows us to provide more comprehensive services,” Arun adds.

For More Information

To learn more about high-risk breast cancer, visit the Breast Cancer: Prevention, Genetics, Causes webpage on the National Cancer Center (NCI) website. For more information about the M. D. Anderson Breast Center High-Risk Clinic, call (713) 792-4215.