Breast Cancer Risk Assessment Warranted in Older Women

Last Updated: 2009-03-10 16:00:32 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Screening for breast cancer risk in postmenopausal women, based on breast density and other factors, identifies patients at high risk who would benefit from chemoprophylaxis and lifestyle changes, according to a report in the Journal of the National Cancer Institute for March 18.

"Although mammographic screening results in decreased mortality from breast cancer, it does not reduce the number of women who develop the disease and who suffer its physical and emotional consequences," Dr. Steven R. Cummings, at the University of California, San Francisco, and co-authors note.

Dr. Cummings" group conducted a systematic review of prospective studies for assessing breast cancer risk and studies regarding interventions for reducing risk.

The Gail model is the most widely used risk model based on demographic characteristics and medical histories, the authors note. However, research showed that it has limited discriminatory accuracy, with the relative risk for women with scores in the highest decile less than 3-fold higher than those in the lowest decile. Moreover, it was not predictive of estrogen receptor-negative cancer.

On the other hand, the review showed that breast density was more strongly associated with breast cancer, with a relative risk of 4.0 for category IV (high) density vs category I (low density). Combining breast density with other risk factors improved discriminatory accuracy.

Although estradiol and testosterone levels are associated with estrogen receptor-positive breast cancer, the investigators maintain that they are unlikely to improve estimates of risk until standardized and inexpensive methods of measurement become available.

"We also found that both tamoxifen and raloxifene reduced the risk of invasive (estrogen receptor-positive) breast cancer," Dr. Cummings and associates report. "Thus, the evidence supports systematic assessment of women"s risk of breast cancer and the recommendation that women at high risk consider chemoprevention to reduce that risk."

Their research also indicated that exercise, weight reduction, a low-fat diet, and limited alcohol intake may reduce risk.

Still, the team concludes, systems to routinely assess risk factors and breast density, and to communicate that information to the patient, have yet to be developed.

J Natl Cancer Inst 2009;101:384-398.


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