High-Risk Benign Breast Lesions: Current Strategies in Management

2007 ◽  
Vol 14 (4) ◽  
pp. 321-329 ◽  
Author(s):  
John V. Kiluk ◽  
Geza Acs ◽  
Susan J. Hoover
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Cancer Chemoprevention ◽  
Breast Lesions ◽  
Management Guidelines ◽  
Increased Risk ◽  
Breast Cancer Chemoprevention ◽  
Benign Breast Lesions ◽  
Screening And Prevention ◽  
High Risk Breast

Background High-risk benign breast lesions can create confusion for both the patient and the clinician. This paper reviews the characteristics of these lesions to help direct appropriate management. Methods The authors reviewed the literature regarding high-risk breast lesions and include management guidelines that we employ at our institute. Results High-risk breast lesions offer varying degrees of increased risk for the future development of breast cancer. Chemoprevention may be used to help decrease the risks from some lesions. Conclusions The management of high-risk benign breast lesions can be confusing. Clinicians should assess the risk of future breast cancer and develop a proper screening and prevention strategy for each individual patient.

scholarly journals Addressing Barriers to Uptake of Breast Cancer Chemoprevention for Patients and Providers

2015 ◽  
pp. e50-e58 ◽  
Author(s):  
Katherine D. Crew
Keyword(s):  
Breast Cancer ◽  
Primary Prevention ◽  
High Risk ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Cancer Chemoprevention ◽  
The United States ◽  
Cancer Risk Assessment ◽  
Breast Cancer Risk Assessment ◽  
Breast Cancer Chemoprevention

Breast cancer is the most common malignancy among women in the United States, and the primary prevention of this disease is a major public health issue. Because there are relatively few modifiable breast cancer risk factors, pharmacologic interventions with antiestrogens have the potential to significantly affect the primary prevention setting. Breast cancer chemoprevention with selective estrogen receptor modulators (SERMs) tamoxifen and raloxifene, and with aromatase inhibitors (AIs) exemestane and anastrozole, is underutilized despite several randomized controlled trials demonstrating up to a 50% to 65% relative risk reduction in breast cancer incidence among women at high risk. An estimated 10 million women in the United States meet high-risk criteria for breast cancer and are potentially eligible for chemoprevention, but less than 5% of women at high risk who are offered antiestrogens for primary prevention agree to take it. Reasons for low chemoprevention uptake include lack of routine breast cancer risk assessment in primary care, inadequate time for counseling, insufficient knowledge about antiestrogens among patients and providers, and concerns about side effects. Interventions designed to increase chemoprevention uptake, such as decision aids and incorporating breast cancer risk assessment into clinical practice, have met with limited success. Clinicians can help women make informed decisions about chemoprevention by effectively communicating breast cancer risk and enhancing knowledge about the risks and benefits of antiestrogens. Widespread adoption of chemoprevention will require a major paradigm shift in clinical practice for primary care providers (PCPs). However, enhancing uptake and adherence to breast cancer chemoprevention holds promise for reducing the public health burden of this disease.

scholarly journals Upgrade of high-risk breast lesions detected on mammography in the Breast Cancer Surveillance Consortium

2014 ◽  
Vol 207 (1) ◽  
pp. 24-31 ◽  
Author(s):  
Tehillah S. Menes ◽  
Robert Rosenberg ◽  
Steven Balch ◽  
Shabnam Jaffer ◽  
Karla Kerlikowske ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Cancer Surveillance ◽  
Breast Lesions ◽  
Breast Cancer Surveillance Consortium ◽  
High Risk Breast

scholarly journals Breast Cancer Chemoprevention among High-risk Women and those with Ductal Carcinoma In Situ

2015 ◽  
Vol 21 (4) ◽  
pp. 377-386 ◽  
Author(s):  
Laura L. Reimers ◽  
Parijatham S. Sivasubramanian ◽  
Dawn Hershman ◽  
Mary Beth Terry ◽  
Heather Greenlee ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Ductal Carcinoma In Situ ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Cancer Chemoprevention ◽  
High Risk Women ◽  
Breast Cancer Chemoprevention

Abstract PR01: Knowledge, attitudes, and uptake of breast cancer chemoprevention in a multi-ethnic cohort of high-risk women

2015 ◽  
Author(s):  
Meghna S. Trivedi ◽  
Laura Reimers ◽  
Katherine Infante ◽  
Dawn L. Hershman ◽  
Matthew Maurer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Cancer Chemoprevention ◽  
High Risk Women ◽  
Breast Cancer Chemoprevention

A phase II breast cancer chemoprevention study of lovastatin in high-risk women: Initial feasibility data

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 1502-1502
Author(s):  
A. W. Kurian ◽  
V. B. Sharma ◽  
E. J. Schwartz ◽  
M. A. Mills ◽  
A. D. Staton ◽  
...  
Keyword(s):  
Breast Cancer ◽  
High Risk ◽  
Comet Assay ◽  
Phase Ii ◽  
Phase Ii Study ◽  
Breast Cancer Incidence ◽  
Cancer Chemoprevention ◽  
High Risk Women ◽  
Duct Cells ◽  
Breast Cancer Chemoprevention

1502 Background: More than 250,000 U.S. women have high inherited breast cancer risk; many develop hormone-receptor negative (ER/PR-) tumors, for which no chemoprevention exists. Pre-clinical data suggest that hydrophobic HMG-CoA reductase inhibitors (statins) may reduce risk of ER/PR- breast cancers. We report initial feasibility results of a phase II study of lovastatin for breast cancer chemoprevention. Methods: Study Design: Single-arm, non-randomized phase II study. Agent: Lovastatin 80 mg daily for 6 months. Primary Endpoint: Change in proportion of women with atypical cytology on 2-quadrant random periareolar fine needle aspiration (rpFNA) of breast duct cells before and after lovastatin. Secondary Endpoints: Changes in Ki-67, ER/PR, and elevated levels of oxidative DNA damage (ODD) measured by single-cell gel electrophoresis (Comet) assay of breast duct cells; changes in mammographic density; breast cancer incidence. Eligibility: BRCA1/2 mutation carrier, or estimated lifetime risk = 20% due to family history. Statistical Considerations: Planned sample size of 60, yielding 90% power to detect 50% change in proportion with atypia. Results: Twenty participants enrolled in Year 1; 15 have pre-study rpFNA and 5 have post-study rpFNA results to date. Pre-Study Cytology: N=15: 1 (7%, 95% confidence interval 0–32%) had insufficient, 11 (73%, 48–90%) had normal, and 3 (20%, 6–46%) had atypical cytology. Pre-Study Comet Assay: N=4 to date, 2 with atypical and 2 with normal pre-study cytology: 2 with atypical cytology (100%, 29–100%) had a positive Comet assay for elevated ODD, but 0 with normal cytology (0%, 0–71%) had a positive Comet assay. Post-Study Cytology: N=5, 1 with atypical cytology pre-study: 5 (100%, 51–100%) were normal post-study. Post-Study Comet Assay: N=1 to date, with atypical cytology and positive Comet assay pre-study: cytology was normal and Comet assay negative post-study. The study has been well-tolerated, with no drop-out. Conclusions: An early-stage chemoprevention study of lovastatin for 6 months, including 2 rpFNAs, appears feasible in high-risk women. Early results suggest a correlation between cytologic atypia and elevated levels of ODD, and the possibility that lovastatin might reverse these abnormalities. Accrual is ongoing. No significant financial relationships to disclose.

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