Breast lumps secondary prevention

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shadan Mehraban, M.D.[2]

Overview

Secondary prevention of breast lumps consists of modifiable risk factors and preventive factors to decrease the rates of breast cancer. The protective factors include controlling alcohol consumption, weight control, physical activity, healthy diet, breast feeding, prophylactic bilateral oophorectomy for BRCA1 and BRCA2 carriers, hormonal replacement therapy avoidance, and use of tamoxifen for high risk women aged > 35 years. In order to reduce breast cancer recurrence, surveillance and follow-up by either physical examination and mammography are required.

Secondary prevention

Benign breast lesions require great attention regarding its influence on patient's quality of life, high prevalence, and the potential of becoming malignant.

• Prevention is considered as the primary method to decrease incidence of new cases of breast cancer.
• Prevention of breast disease may be associated with establishing modifiable risk factors.

Premenopausal women

• Modifiable risk factor in pre-menopausal women include:
  • Alcohol intake:
    • No alcohol intake for youth aged 12-17 years may lead to 20-30% possible risk reduction and takes 10-20 years for the benefit of decreasing the risk.
    • ≤1 serving/day alcohol intake for young adults 18-24 years may lead to 20-30% possible risk reduction and take 10-20 years for the benefit of decreasing the risk.
    • ≤1 serving/day alcohol intake for adults ≥18 years may lead to 35% possible risk reduction and take 10-20 years for the benefit of decreasing the risk.
  • Weight control:
    • Avoid weight gain in all women may lead to 50% risk reduction after menopause and take 10-30 years for the benefit of decreasing the risk.
  • Physical activity:
    • ≥ 30 min/day, for inactive women may lead to 20% risk reduction and take 10-30 years for the benefit of decreasing the risk.
  • Healthy diet:
    • Such as fruit, vegetables, and whole grains may lead to 20-50% risk reduction and take 5-20 years for the benefit of decreasing the risk.
  • Breast feeding:
    • At least 1 year of breast feeding after delivery of a pregnant women may lead to 18% risk reduction and take 5 years for the benefit of decreasing the risk.
  • Prophylactic bilateral oophorectomy:
    • For carriers of BRCA1 and BRCA2, oophorectomy may lead to 50% risk reduction and take ≥ 2 years for the benefit of decreasing the risk
  • Tamoxifen:
    • Use of tamoxifen in high risk women aged ≥35 years may lead to 50% risk reduction and take 2 years for the benefit of decreasing the risk.

Postmenopausal women

• Modifiable risk factor in post-menopausal women include:
  • Alcohol intake:
    • ≤1 serving/d may lead to 35% risk reduction and take 5-10 years for the benefit of decreasing the risk.
  • Weight control:
    • Weight loss for overweight and obese women > 145 lbs may lead to 50% risk reduction and take 2-5 years for the benefit of decreasing the risk.
  • Physical activity:
    • ≥30 min/day for women (who have no contraindication to physical activity) may lead to 20% risk reduction and take 10-20 years for the benefit of decreasing the risk.
  • Avoid estrogen and progestin postmenopausal hormone therapy
    • May lead to 10% risk reduction for current users and take 1 year for the benefit of decreasing the risk.
    • May lead to 50% risk reduction for current users and take 2 years for the benefit of decreasing the risk.
  • Usage of tamoxifen and raloxifen:
    • For high risk women with greater than or equal risk for average woman aged 60 years, use of tamoxifen and raloxifen may lead to 50% risk reduction and take 2 years for the benefit of decreasing the risk.

Surveillance and Follow-up

• Surveillance and follow-up to reduce breast cancer recurrence is recommended as follows:
  • History and clinical physical examination is required every 4 to 6 months for 5 years.
  • Annual mammography and clinical physical examination after first 5 years.
  • Annual gynecological assessment for uterus evaluation for women on tamoxifen.
  • Bone health assessment for women on aromatase inhibitor and those who had ovarian failure secondary to treatment.
  • Establishment of physical activity, reduced alcohol intake, weight control measures.