A bitter inheritance: Options for reducing your cancer risk

By Shari Roan
Los Angeles Times

Friday, November 2, 2007 10:34 AM CDT

Women who carry the genetic mutations for breast and ovarian cancer have several options to help prevent the diseases. Some of the options are fairly easy to implement but don’t lower the risk by much. Others greatly reduce risk but are difficult to maintain or are harshly life-changing.

Surveillance: In this watch-and-wait approach, women undergo a clinical breast exam and mammogram or MRI at least once a year, and they conduct breast self-exams. The idea is to catch a tumor as early as possible, but the approach doesn’t reduce the risk of getting cancer.

This option worries some women because the gene mutations tend to cause faster-growing cancers that might emerge between exams. But doctors report that technical advances in imaging the breast are transforming surveillance into a better option.

Lifestyle changes: Because reducing exposure to estrogen lowers breast cancer risk, women can choose to limit their intake of fat and alcohol, which tend to raise estrogen levels. Exercise, in contrast, is thought to reduce circulating estrogen.

Breast-feeding also appears to lower breast cancer risk, for reasons that aren’t completely understood. Research has not shown whether these actions specifically benefit women with gene mutations.

Chemoprevention: This involves taking medications that might lower cancer risk, such as the well-known tamoxifen , for several years. Side effects, however, can cause women to stop taking the medications before they have time to work, and scientists aren’t sure how helpful the medications are in women with BRCA gene mutations, especially those with BRCA1.

A drug similar to tamoxifen, called raloxifene or Evista , was approved Sept. 14 to reduce the risk of breast cancer in high-risk post-menopausal women and post-menopausal women with osteoporosis. It is thought to work as well as tamoxifen in preventing breast cancer and with fewer side effects. However, raloxifene has not been studied specifically for prevention in women carrying a BRCA mutation.

Aromatase inhibitors, now used to treat breast cancer in postmenopausal women, also might help prevent cancer in high-risk postmenopausal women. These drugs might prove to work better than tamoxifen or raloxifene and with fewer side effects.

Prophylactic surgery: Removing the ovaries dramatically reduces the risk of ovarian cancer and is thought to halve the risk of breast cancer. Removing the breasts lowers breast cancer risk by an estimated 91 percent. Dramatic though such surgeries are, neither approach is 100 percent effective.

In addition, prophylactic oophorectomy — recommended for premenopausal women with a BRCA mutation — causes premature menopause. Prophylactic mastectomy is disfiguring, and many patients then opt for breast reconstructive surgery. Reconstructive methods are improving, but not all surgeons specialize in the latest techniques

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