Preventative Treatment

If you are in a high risk category, you should be regularly screened. Preventative treatment may be considered. 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.

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