Prevention and Lifestyle Factors

Investigational Drugs. The following investigative drugs are showing promise for prevention:

• Aromatase inhibitors are proving to be effective treatments for hormone-receptor positive breast cancer. Like tamoxifen, they are also being investigated for protection in high-risk women.
• Retinoids. Analogues of vitamin A called retinoids are being studied for protection against breast cancer. One retinoid, fenretinide, appears to offer some protection against a second breast cancer in previously diagnosed, premenopausal women (but not in postmenopausal women).

Prophylactic Mastectomies and Oophorectomies. Studies suggest that preventive breast removal (called prophylactic mastectomy) reduces the risk of breast cancer by about 90% in women who harbor BRCA genetic mutations. Shutting down estrogen production with preventive oophorectomy (ovary removal) is also proving to be an effective alternative in reducing the risk of breast cancer in women with BRCA1 gene mutations, and possibly BRCA2.

Click the icon to see an image of the uterus and ovaries.

Still, the decision is not easy. Having the genes does not mean that cancer will always occur, meaning that mastectomy might not be necessary in all such women. Furthermore, even after mastectomy, some precancerous cells may persist that can activate the disease later on. Nevertheless, in one 2000 study, 70% of women were satisfied with their decision to have prophylactic breast removal. Women should discuss all options with their doctors, including oophorectomy and close monitoring.

Oophorectomy causes immediate menopause. Women who have a “surgical menopause” often experience more severe symptoms of hot flashes, sleep disturbances, and vaginal dryness than women who have a natural menopause. Hormone replacement therapy (HRT) is sometimes prescribed to help ease these menopausal symptoms. However, long-term use of HRT is a risk factor for breast cancer. A 2005 study suggested that short-term (less than 3 years) HRT is safe for women who have had preventive oophorectomy and will not increase their risk of developing breast cancer.