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New Risk Factors for Breast Cancer Added to Guidelines for Counseling and Treatment: Presented at NCCN

By Ed Susman

HOLLYWOOD, FL -- March 20, 2007 -- A woman's body mass index, breast density and alcohol consumption have been added as risk factors for assessing if that woman should receive treatment -- either surgery or drugs such as tamoxifen -- to decrease risk of breast cancer.

Therese Bevers, MD, medical director of the Cancer Prevention Center, at the University of Texas M.D. Anderson Cancer Center in Houston, Texas, United States, said the elements of risk for women include more than a dozen areas -- including whether a woman carries the BRCA 1 or BRCA 2 genetic mutations that increase her risk of breast cancer to as much as 85%.

A woman's age is one of the key risk factors in development of breast cancer and a factor that affects whether the woman should be taking medical treatment.

"Utility of tamoxifen or raloxifene for breast cancer risk reduction in women under 35 years of age is unknown," Dr. Bevers noted in her presentation of the treatment algorithm on March 16^th at the 12^th annual National Comprehensive Cancer Network (NCCN) Conference on Clinical Practice Guidelines and Quality Cancer Care.

Another factor that affects breast cancer risk is the woman's ethnicity and race. Dr. Bevers noted an increased risk of BRCA 1/2 mutations among Ashkenazi Jewish women. However, she said that the mutation is also beginning to appear in other women as well.

Doctors should also take a family history that goes back at least 3 generations, she said, and that history should include the proband, offspring, paternal and maternal generations and should include the age of cancer diagnosis.

Other risk factors include the age of menarche, parity, age at first live birth and age of menopause.

The number of biopsies performed for suspicious lesions in the breast should also be considered, but Dr. Bevers noted: "By biopsies we only count those done with the intent to diagnose cancer; multiple biopsies of the same lesion are scored as 1 biopsy."

The previous treatment or diagnosis of atypical hyperplasia or lobular carcinoma in situ is another factor to be considered.

Dr. Bevers said that physicians should determine if their patient has previously undergone radiotherapy for the treatment of diseases such as Hodgkin's disease. These women are at most risk for breast cancer, aside from those with genetic predisposition to cancer.

The known genetic mutations that put women at increased risk of breast cancer include BRCA 1, BRCA 2, p53, PTEN and other gene mutations

Current or prior oestrogen and progesterone hormone replacement therapy is also a risk factor for the disease.

The guidelines offer treatment options for women, including bilateral mastectomy and oophorectomy for women who have tested positive for 2 genes -- BRCA1 and BRCA2. They also offer possible medical treatments with drugs such as tamoxifen and raloxifene.


[Presentation title: Update: Breast Cancer Risk Reduction Guidelines.]

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