Breast Cancer Prevention
Breast Cancer Prevention Options
Below are some of the questions people ask about breast cancer prevention and details about available medical options.
Can breast cancer be prevented?
There are no medical options that completely prevent breast cancer, but it is possible to lower the risk substantially. The two main approaches for high-risk people to lower their risk for breast cancer are:
- medications (sometimes called ).
- risk-reducing mastectomy (sometimes called prophylactic surgery).
Each approach has different benefits and risks and some risk remains with each option.
How effective are medications for lowering breast cancer risk?
The medications approved for reduce the risk for breast cancer by about half. Most of the research on these medications have studied women with increased risk for breast cancer due to a family history of cancer or certain breast changes found on biopsy.
There has been very little research on how well they work in women with an linked to breast cancer risk and how much risk remains. For this reason, most experts advise high-risk women to continue screening while on .
How effective is surgery for lowering breast cancer risk?
For women with a high risk for breast cancer due to an , risk-reducing surgery is the most effective way to lower the risk for cancer. Experts estimate that removal of both breasts (called mastectomy) lowers the risk for breast cancer by at least 95%.
Mastectomy does not completely eliminate the risk for breast cancer. Small amounts of breast tissue may remain even after surgery. Because the remaining risk is so small, most experts do not recommend routine breast cancer screening after risk-reducing surgery.
Which medications can lower the risk for breast cancer?
The two types of medications used to lower the risk for breast cancer in women are called selective reuptake modulators (SERMs) and aromatase inhibitors (AIs). Both block the hormone .
High-risk women who wish to consider medications to lower their risk for breast cancer should discuss the benefits, risks and limitations with their health care provider.
SERMs (Selective Receptor Modulators)
The two SERMs most commonly used to lower breast cancer risk are tamoxifen and raloxifene.
- Tamoxifen is used both to treat and prevent breast cancer. It works for both pre- and postmenopausal women. When taken for five years, it reduces breast cancer risk by about 40%; this protective effect continues even after the medication is stopped. Tamoxifen strengthens bones and reduces the risk for in postmenopausal women. Side effects of tamoxifen may include hot flashes, an increased risk of endometrial cancer and blood clots. A lower dose of tamoxifen (sometimes referred to as "Baby Tam") may offer similar protection while reducing side effects.
- Raloxifene works in a similar way as tamoxifen but is only used in postmenopausal women. Raloxifene has a lower risk for endometrial cancer and blood clots and fewer side effects than tamoxifen. The most common side effects are hot flashes, blood clots, nausea and weight gain.
Aromatase inhibitors are medications that block production of in postmenopausal women. Common aromatase inhibitors include anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin).
Unlike SERMs, aromatase inhibitors do not improve bone density. In fact, they may actually accelerate bone loss in postmenopausal women. However, aromatase inhibitors tend to cause fewer side effects and do not appear to have the risk of blood clots or endometrial cancer seen with tamoxifen.
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Who should consider taking ?
The decision to take medication to reduce the risk for breast cancer is a very personal decision that is not right for everyone. The National Comprehensive Cancer Network (NCCN), is an organization of cancer experts that creates guidelines on cancer care and updates them yearly.
The guidelines recommend that people with an increased risk for breast cancer discuss the benefits, risk, limitations and costs of with their doctor, in order to make a decision that is right for them. The guidelines point out that most of the research on the medications approved for has not studied how well the medications work in women with inherited mutations.
Does insurance cover the cost for ?
The federal Affordable Care Act requires most health insurance companies to pay for medications to lower the risk for breast cancer in high-risk women 35 and older with no out-of-pocket costs. Visit our page on paying for preventive care for more information.
Despite federal and , some health plans still deny coverage for high-risk screening or charge large out-of-pocket fees. You can file an appeal with your health plan. Visit our page with tips for filing an appeal.
Summary of breast cancer options
|
Tamoxifen |
Raloxifene |
Aromatase Inhibitors |
|
Pre- or post-menopausal |
Post-menopausal |
Post-menopausal |
|
Approximately 50% reduction in risk |
Approximately 50% reduction in risk |
Approximately 50% reduction in risk |
|
Some research in mutation carriers suggests more benefit for prevention in than . Other genes have not been studied. |
Not studied for prevention in people with inherited mutations. |
May lower risk for breast cancer in mutation carriers based on treatment studies in and mutation carriers. Other genes have not been studied. |
Are there vaccines or other medications that can prevent breast cancer?
Researchers are testing other drugs and vaccines to see if they can lower breast cancer risk in high-risk people.
- The drug denosumab is used to increase bone strength in people with (bone weakening) or people with cancer who are at risk for bone weakening. A study known as BRCA-P is looking at whether this drug could lower the risk for breast cancer in high-risk women.
- PARP inhibitors are targeted therapies used to treat cancer in people with or mutations. Researchers are looking at designing studies using PARP inhibitors to lower the risk for cancer in people with these mutations.
- Several different vaccines are being tested in clinical trials.
What is a risk-reducing mastectomy?
Mastectomy is surgery to remove one or both breasts to prevent breast cancer. “Prophylactic mastectomy” or "risk-reducing mastectomy" refers to the removal of healthy breasts to reduce a person's risk of developing breast cancer. You can learn more about mastectomy surgery here.
Who should have a risk-reducing mastectomy?
Undergoing risk-reducing surgery is a very personal decision that is not right for everyone. The National Comprehensive Cancer Network guidelines recommend that people with the mutations in the genes listed below discuss the benefits, risk, limitations and costs of risk-reducing mastectomy with their doctor, in order to make a decision that is right for them.
Can women with other mutations or strong family history of breast cancer have risk-reducing mastectomy?
For women with mutations in other genes or those with a strong family history of breast cancer, the NCCN recommends basing the decision of mastectomy on personal and family history of cancer.
NCCN recommends increased screening for high-risk women who choose not to have risk-reducing mastectomy.
Can men with mutations have risk-reducing mastectomy?
The guidelines do not recommend risk-reducing mastectomy to lower the risk for male breast cancer. For men diagnosed with breast cancer, treatment usually involves mastectomy on the affected side. Some men who have been diagnosed with breast cancer in one breast choose to remove both breasts.
Does insurance cover the cost for risk-reducing mastectomy?
Most insurance plans will cover the cost of risk-reducing mastectomy for certain high-risk people, however out-of-pocket costs may apply. Visit our page on paying for preventive care for more information.