> Emerging Areas in Estimating Risk and Risk Reduction
Breast cancer prevention is an active area of research. Some research focuses on the best ways to promote health and increase awareness about factorspeople can control that may lower their breast cancer risk.
Other studies look for new and better ways of knowing which women are at higher risk of breast cancer and methods of reducing their risk, such as risk-lowering drugs.
Some studies look at the benefit of educational programs to promote breast cancer awareness and ways to lower risk. For example, government agencies and health organizations produce mass media campaigns. They study these efforts to see how well they help people learn about lifestyle changes that may lower breast cancer risk.
For example, the Centers for Disease Control and Prevention (CDC) produced a mass media campaign to increase awareness of its National Breast and Cervical Cancer Early Detection Program (NBCCEDP). NBCCEDP provides access to breast cancer screening to underserved women in the United States and the CDC wanted to increase awareness about this program. They first needed to find a way to reach these women. They designed a mass media campaign for a few cities in Georgia. The campaign included ads on radio stations that mainly had an African American audience. The CDC surveyed African American women before and after the campaign to see whether they were aware of NBCCEDP. They found that women were more aware of NBCCEDP after the radio campaign. Thus, the CDC learned that using ads on the radio stations that the women they wanted to reach listened to was a good way to increase awareness about breast cancer programs among those women .
Using breast cells to assess risk
Methods to assess breast cancer risk currently under study include [273-279]:
- Ductal lavage
- Nipple aspiration (nipple aspirate fluid cytology)
- Random periareolar fine needle aspiration (RPFNA)
These procedures remove cells from the breast. A pathologist looks at the cells under a microscope. Abnormal (atypical) cells are linked to an increased risk of breast cancer.
The procedures differ in how the cells are removed from the breast.
Ductal lavage uses a small tube to flush out fluid from the nipple. This fluid contains breast cells. The procedure causes some discomfort .
Ductal lavage is becoming more common in the United States and many breast centers now offer it to women at higher risk. However, more research is needed to learn how to use the findings from this test.
Nipple aspiration (nipple aspirate fluid cytology)
Nipple aspiration (such as the HALO test) uses a breast pump (and sometimes massage) to remove fluid from the nipple. Nipple aspiration is becoming more common in the U.S. and many breast centers now offer it to women at higher risk. However, more data are needed to learn how to use the findings from this test.
Random periareolar fine needle aspiration (RPFNA)
RPFNA uses a thin needle to remove cells from about 10 areas near the areola. This procedure is more invasive and causes more discomfort than ductal lavage, nipple aspiration or fine needle aspiration done for diagnosis. RPFNA is offered mainly in clinical studies.
Ductal lavage, nipple aspiration or RPFNA and risk assessment
At this time, finding abnormal cells on ductal lavage, nipple aspiration or RPFNA should not affect a woman's decision to take tamoxifen or raloxifene or to join a risk reduction clinical trial.
If you are interested in one of these tests, talk to your health care provider. He/she may be able to give you a referral to a breast center with expertise in risk assessment and risk reduction.
Risk-lowering drugs (chemoprevention)
Some drugs used in breast cancer treatment are under study for their use in prevention and new risk-lowering drugs are being developed.
Learn about FDA-approved drugs for lowering the risk of breast cancer.
The hormone drugs aromatase inhibitors are used to treat estrogen receptor-positive breast cancer in postmenopausal women (learn more). There are three aromatase inhibitors that are FDA-approved for use in the United States: anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin). They appear to be equally effective in treating breast cancer. These drugs are now being studied to see whether they lower risk in postmenopausal women at high risk of breast cancer.
Findings from a recent randomized controlled trial of 4,560 cancer-free postmenopausal women at high risk showed the aromatase inhibitor exemestane lowered the risk of breast cancer. After three years, women taking exemestane had a 65 percent lower risk of developing invasive breast cancer than women taking a placebo .
Unlike tamoxifen and raloxifene, exemestane did not appear to increase the risk of blood clots. However, similar to tamoxifen or raloxifene, menopausal symptoms were more common among women taking exemestane compared to placebo . Other studies have shown aromatase inhibitors can cause a loss of bone density [268-271].
Although exemestane is FDA-approved for use in breast cancer treatment, it is does not yet have FDA-approval for use in the chemoprevention setting.
Learn about aromatase inhibitors and breast cancer treatment.
Bisphosphonates are a group of drugs used to help strengthen bones. Bisphosphonates are used to treat and lower the risk of osteoporosis. These drugs alsoplay a role the treatment of early and metastatic breast cancer. Women taking aromatase inhibitors to treat early breast cancer may use bisphosphonates to help maintain bone density. (Aromatase inhibitors can cause a loss of bone mineral density.) And, people with metastatic breast cancer may use these drugs to lower the risk of bone metastases.
Early study results have foundbisphosphonates may also lower the risk of breast cancer in women at risk of osteoporosis . More data are needed to confirm these findings and to learn how they relate to other women. The women in the study were at risk for osteoporosis due to their low bone density, a factor linked to a lower risk of breast cancer. This makes it hard to know whether women in the study had a lower risk of breast cancer because of their use of bisphosphonates or because of their low bone mineral density.
Learn more about bone mineral density and breast cancer risk.
Lasofoxifene is an osteoporosis drugsimilar to tamoxifen and raloxifene. Early findings suggestlasofoxifene may reduce the risk of estrogen receptor-positive breast cancer in women at risk for osteoporosis . More data are needed to confirm these findings.
Clinical trials of risk-lowering drugs
If you are at higher risk of breast cancer and are considering joining a clinical trial of risk-lowering drugs, discuss the potential risks and benefits with your health care provider.
BreastCancerTrials.org in collaboration with Susan G. Komen for the Cure offers a custom matching service that can help you find a clinical trial on risk reduction for healthy women and women at high risk of breast cancer.
Learn about clinical trials.