7 things you should know about breast cancer risk

What to do? Unfortunately, breast tumors (both cancerous and noncancerous) can be difficult to distinguish against a background of dense breast tissue on a mammogram. That’s because tumors and dense tissue appear white; fatty tissue, on the other hand, looks darker and provides a contrast to the tumors. Digital mammography has been shown to improve cancer detection in women with dense breasts, because it allows the radiologist to fine-tune images so that tiny abnormalities stand out better. Ultrasound or MRI can also help answer questions raised by a suspicious mammogram. Much more needs to be learned about breast density before official recommendations can be made. In the meantime, if you have dense breasts, talk to your clinician about screening with digital mammography.

Lifestyle choices that show possible, probable, or convincing benefits for reducing breast cancer risk

1. Increasing vegetable and fruit intake
2. Increasing physical activity
3. Avoiding overweight
4. Limiting alcohol use
5. Taking folic acid supplements

Source: Adapted from “American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention,” CA: A Cancer Journal for Clinicians (March/April 2002), Vol. 52, No. 2, pp. 92–119.

7. Chemoprevention

In 1998, the 13,000-woman Breast Cancer Prevention Trial demonstrated that taking the anti-estrogen drug tamoxifen (Nolvadex) for five years cut the incidence of breast cancer by 49% in women at increased risk for the disease. Another prevention trial, the Study of Tamoxifen and Raloxifene (STAR), reported in 2006 that raloxifene (Evista) — already approved for preventing osteoporosis in postmenopausal women — works as well as tamoxifen in reducing the risk of invasive breast cancer. Newer drugs called aromatase inhibitors, which are approved for the treatment of breast cancer, are in trials as preventives, but results won’t be known for several years.

What to do? If you have an elevated risk for breast cancer due to family history, age, genetic mutations, or other factors, talk to your clinician about whether tamoxifen or raloxifene might be appropriate for you. Both pre- and postmenopausal women can take tamoxifen; only postmenopausal women can take raloxifene. Both drugs can have serious side effects — for example, tamoxifen increases the risk for endometrial cancer — so you’ll need to weigh the decision carefully.