Shifting the breast cancer paradigm from “Diagnosis and Treatment to Risk Assessment and Prevention”
For many years, we focused on improving treatments for breast cancer. During that time, breast cancer treatment has improved dramatically and will likely be more refined over the next few decades. What has changed the paradigm from treatment to prevention is that we have discovered ways to identify patients at risk which allows us to sort those patients out and follow them more closely.
The first thing that has allowed us to do this is genetic testing- this has allowed us to test patents with significant family history and find out if they are genetically programmed to develop breast cancer.
Secondly, we have identified risk models that allow us to look at a woman’s individual risk factors and determine how her risk for breast cancer compares with that of women with no risk factors.
Lastly, the HALO Breast Pap Test has allowed us to identify precancerous changes before they move forward to the cancerous stages. This is particularly good in women with no family history to see if they may be at risk for cancer development. This gives us an opportunity to make interventions and prevent the subsequent steps to cancer.
Of course none of this would be possible if we did not have acceptable interventions for those who may be identified as high risk.
Tamoxifen, an antiestrogen therapy used to treat breast cancer for many years, has been shown to reduce the risk of developing breast cancer in women with family history and/or precancerous changes.
Preventative mastectomy has been shown to reduce the risk of breast cancer development by 90%. May women with the genetic mutation ( BRCA1) or BRCA2), atypical changes (precancerous) or some with just family history choose this operation.
Modern day reconstruction can result in breasts that look very natural and in some cases appear more youthful than the patient’s natural breast. Let’s face it - time and breast feeding may play a role in breast changes and many of us have thought about procedures that may make them look more youthful!
These are very serious and individual choices but should be discussed with your breast care specialist so that the best treatment plan for your level of risk can be developed!
