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Preventative Treatment

If you are in a high risk category, you should be regularly screened. You may consider preventative treatment. This comes in two forms: hormone therapy or surgery, depending on your particular circumstances.

Hormone Therapy

In patients with ADH, ALH, DCIS, LCIS and BRCA2, chemoprevention is a preventative treatment that may be considered. This means taking a hormone therapy (Tamoxifen in pre or postmenopausal women and an Aromatase Inhibitor in postmenopausal women) for 5 years as a prevention strategy to prevent breast cancer from occurring. Taking this therapy reduces the risk of developing a breast cancer in either breast by 50%. This treatment does not work in BRCA1 carriers as they rarely develop ER+/PR+ tumours and are more likely to develop TNBC. BRCA2 carriers tend to develop ER+/PR+ cancers and may receive more benefit from this strategy.

Prophylactic Surgery

In BRCA carriers and patients with a lifetime risk of getting a breast cancer of more that 25% as calculated by the IBIS and Gail model, bilateral prophylactic mastectomy is an option. This procedure reduces the risk of developing a breast cancer by 90% and in BRCA carriers may offer a survival benefit. This survival advantage has not been shown for high risk patients that are not BRCA carriers. This benefit is often greater in younger patients

The types of surgery offered include:
Bilateral Skin-sparing Mastectomy with implant based or tissue based immediate reconstruction.
Bilateral Nipple-Skin sparing Mastectomy with implant based or tissue based immediate reconstruction (leaving the nipple behind carries a risk of less than 1% of cases developing cancer in the nipple).
Bilateral Classic Mastectomy with delayed reconstruction.

In BRCA carriers, especially in premenopausal women, removal of the ovaries is recommended. Your doctor will want you to be sure that you are ready to make this major decision that affects your fertility in a drastic way. This procedure reduces the risk of ovarian cancer and further reduces the risk of breast cancer. Removal of the ovaries in postmenopausal BRCA carriers only reduces the risk of ovarian cancer and has no effect on the breasts. Bilateral oophorectomy is most effective if done around or under the age of 40.

next steps:

Welcome to the BTC Treatment Decision ToolHave you or someone you love recently received a diagnosis of breast cancer?

Whether you received a diagnosis yesterday or three months ago, you are likely dealing with an upheaval in your life as you’ve known it. Perhaps you have also started the process of meeting with your doctors to discuss what treatment options are available, and which therapies (or combination of therapies) will be the best for you. It is a lot of information to sort through and make sense of.

So we’re here to help.

The team at Be the Choice are a diverse group of women and men who have had experiences with a breast cancer diagnosis and treatment. Some of us have undergone treatment for breast cancer, some of us have provided care for a loved one who has been through treatment, and some of us are physicians and other health care professionals who provide treatment to breast cancer patients.

United in our concern that all people who receive a diagnosis of breast cancer should have access to comprehensive, state-of-the-art treatment information in a comfortable and user-friendly format, we designed this interactive treatment decision tool.

How to use:

Your diagnosis of breast cancer has come with an assessment of your unique clinical and hormonal characteristics. These should be carefully discussed with your medical team and deliberated carefully in advance of any treatment decisions.

This tool will enable you to get to know the “big picture” as well as the “individual picture” behind any breast cancer treatment decision, and to become an active participant in determining your own treatment process. You are the ultimate decision-maker in this process. We hope that you will use the information on this website to inform and empower yourself.

What this tool is not designed to do is deliver individual treatment recommendations. It should be used as a way to get a sense of the full range of treatments available to you as well as what your own treatment plan might look like given your unique profile.