Prevention of Breast cancer and FAQ

Prevention of breast cancer can not be guaranteed. But can be done by lowering the risk factors of breast cancer.

Updated: June 16, 2022

Prevention of breast cancer can not be guaranteed. However, reviewing the risk factors and modifying the ones that can be altered such as increasing exercise, maintaining a good body weight, etc can help in decreasing the risk. Following the American Cancer Society's guidelines for early detection can help early detection and treatment.

Prevention of breast cancer:

This can be done by lowering the risk factors of breast cancer.

Breast cancer risk reduction for women with an average risk:

Lifestyle changes may help reduce your risk of breast cancer. These include:

Do breast cancer screening before time:

Discuss with your doctor when to begin breast cancer screening examination and tests, such as clinical breast exams and mammograms. The benefits and risks of screening should be discussed with your doctor before deciding breast cancer screening strategies for you.

Do self examination of your breast for breast awareness:

Occasionally inspecting your breasts during a breast self examination for breast awareness can make you familiar with your breasts. Talk to your doctor promptly if you find a new change, lumps or other unusual signs in your breasts. Although breast awareness can't prevent breast cancer, but it may help you to better understand the normal changes that your breasts undergo and identify any unusual signs and symptoms and make the cancer detectable in its early stage.

Limit alcohol:

Limit the amount of alcohol you drink to no more than one drink a day, if you choose to drink. Drinking alcohol in moderation can prevent breast cancer.

Do Regular Exercise:

Exercise most days of the week. Aim for at least 30 to 45 minutes of exercise on most days of the week.

Avoid postmenopausal hormone therapy:

Combination hormone therapy may increase the risk of breast cancer. Talk with your doctor about the benefits and risks of hormone therapy. If you have bothersome signs and symptoms during menopause and choose HRT as an option in order to relieve menopause signs and symptoms, that will increase your risk of developing breast cancer. Use alternative methods or if required the lowest dose of hormone therapy possible for the shortest amount of time to reduce the risk of breast cancer.

Maintain a healthy weight:

If your weight is proper as per BMI standard, work to maintain that weight. But if you need to lose weight, ask your doctor about different strategies to achieve a healthy weight. Reducing the number of calories you eat each day and slowly increasing the amount of exercise can help you reduce your weight if you are overweight or obese.

Choose a healthy diet:

Following a Mediterranean diet supplemented with extra virgin olive oil and mixed nuts may have a reduced risk of breast cancer. The Mediterranean diet focuses mostly on plant based foods, such as fruits and vegetables, whole grains, legumes, and nuts. Healthy fats, such as olive oil, over butter and fish instead of red meat is recommended in this diet.

Breast cancer risk reduction for women with a high risk:

Women with a strong family history of breast cancer or precancerous breast condition need additional preventive measures. Women with a strong family history of breast cancer should be evaluated by genetic testing. This should be discussed with a health care provider and be preceded by a meeting with a genetic counselor who can help interpret the results after testing.
The options to reduce your risk, if you have a high risk factor such as family history of breast cancer or precancerous breast condition include:

Chemoprevention or Preventive medications:

Estrogen-blocking medications, such as selective estrogen receptor modulators and aromatase inhibitors, reduce the risk of breast cancer in women with a high risk of the disease. As these medications have a risk of side effects, it is used only for those women who have a very high risk of breast cancer. Discuss the benefits and risks with your doctor before starting these medications.

Preventive surgery:

Women with a very high risk of breast cancer may choose to have their healthy breasts surgically removed which is known as prophylactic mastectomy. They may also choose to have their healthy ovaries removed or prophylactic ophorectomy to reduce the risk of both breast cancer and ovarian cancer.
Although this reduces the risk significantly, a small chance of developing cancer remains. Such an approach should be carefully discussed with a health care team.
The following things should be kept in mind when discussing about whether to undergo any preventive surgery should include

  • genetic testing for BRCA1 or BRCA2 gene mutations,
  • full review of risk factors,
  • family history of cancer and specifically breast cancer, and
  • other preventive options such as medications

Some questions that usually comes in mind about Breast cancer:

How difficult it is to confirm a breast cancer?

Certain types of cancer are relatively easy to identify by a biopsy which include standard microscopic evaluation of the tissue that was reviewed by a pathologist. This is generally true for the most common types of breast cancer. However, it can be difficult to be certain that a particular group of cells is malignant or cancerous in case of rarer forms of breast cancer. Also, benign conditions may have cells that are somewhat distorted in appearance or pattern of growth known as atypical cells or atypical hyperplasia.
Therefore, it is important that the pathologist reading the slides of your breast biopsy should be experienced in breast pathology. In more difficult cases, the slides will often be sent to recognized specialists with considerable expertise in breast pathology.

What difference does a precise breast cancer diagnosis make?

A precise diagnosis determines the recommended treatment. Treatment must be specifically tailored to the specific type of breast cancer as well as to the overall condition of individual patient. A doctor should be able to give someone a clear description of the type of breast cancer along with the treatment options with its pros and corns.

What if I have cancer in other areas of the same breast or in my other breast?

If you have more than one area of malignancy in the same breast or even an additional malignancy in the other breast, the treatment options will be different then a usual breast cancer. Careful investigation is required beyond the immediate site of the tumor to make certain there are no other areas with possible malignancy.
Discovering these secondary areas requires careful review of your mammograms. An by ultrasound, MRI, or other imaging techniques may also be used to take the addition of special views from different angles. Sometimes imaging techniques will be used to evaluate the rest of your body, as well.

What type of medical team do involve in accurate breast cancer diagnosis and treatment?

Oncologists are physicians who specialize in cancer care and will be involved in your care. They will often coordinate with your primary care provider. Pathologists is a physicians who diagnose tissue obtained during biopsies, radiologists, and surgeons will often be involved in the care, as well. Advice from the entire team must be taken in to consideration during biopsies and any tumor clearing surgery. This will ensure the best chance of a favorable outcome for the patient.

How important is the role of the pathologist reading my slides?

The slides made from fine needle aspiration biopsies, core biopsies, and tissue slides of the breast must be evaluated by a pathologist who have a great deal of experience and special training. It is important that the pathologist reliably determine the presence or absence of cancer and distinguish cancer from other conditions such as hyperplasia with atypia.
The pathologist also orders and interprets special studies on your cancer tissue to determine the precise characteristics of the cancer cells, such as whether the cancer expresses hormone receptors. These results are used to further specify the type of breast cancer and optimize treatment decisions.

Does my slide require review by more than one pathologist? 

The added safeguard of double reading may not be necessary in most cases of breast cancers but can be a critical factor in some cases. Double reading of slide can lead to both over reading (making a false positive diagnosis) and under reading (making a false negative diagnosis). When slides are read a second time by another pathologist followed by a discussion of the conclusions, most diagnostic problems are resolved. However, this is not a standard procedure at all hospitals.

Is it possible to have my biopsy reviewed by a pathologist at another diagnostic center?

As breast cancer is almost never an emergency, it should always be possible to send slides from your biopsy to a pathologist at another diagnostic center to get a detail picture. A good, thorough pathological evaluation as well as a complete workup of both breasts is required for deciding the best treatment plan. Therefore You should discuss this with your treatment team or primary care provider as they can help you arrange for this. It is not necessary to obtain this in-depth consultation in most cases of breast cancer. However, in case of any unusual aspects, it can be important in decision making process. It may take a week or more to obtain additional consultation.

How much family history relevant to my breast cancer diagnosis?

The information of having have a strong family history for breast cancer, ovarian cancer, or even prostate cancer, is relevant to your diagnosis. A strong family history in this case usually means that a mother, sibling, child, or father has had a related malignancy. Information about other family members such as aunts, nieces, etc is also important.
If the diagnosis of breast cancer was made at an early age or involved both breasts or a breast and an ovary in the same individual, these information are significant as it requires a more comprehensive diagnostic workup, more involved treatment, and consideration of genetic testing, not only for you but for other family members.

What other studies should be done on my breast tissue biopsy during diagnosis?

The slides made from involved tissue will be evaluated under microscope to get the critical information about the tumor. The tumor behavior can be made based on the appearance of the cancer cells, their size and similarity to one another, and the presence or absence of these cells in the lymphatic and blood vessels immediately adjacent to the tumor. This type of evaluation is a standard part of the diagnostic process.
However, the additional relevant data such as an assessment of the estrogen and progesterone receptors on the malignant cells and the status of at least one oncogene, called her-2-neu should be studied by by the pathologist at the time of diagnosis. An oncogene is a gene that plays a normal role in cell growth but, when altered, may contribute to abnormal cell division and tumor growth. Currently estrogen and progesterone receptors and her-2-neu testing are done in all cases of breast cancer where the test results are available within a few days to a week after removal of the tumor tissue. The results of these tests are important in deciding the treatment options. As these tests are constantly evolving and changing, your treatment team will be able to discuss the current standard and advanced testing available.
Certain breast cancers requires genomic assays or the tests that evaluate gene expression in the tumor tissue to help determine the likelihood of recurrence of tumor. It also help determine whether chemotherapy will be beneficial.

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