Certain Breast Changes

If you've been diagnosed with certain benign (not cancer) breast conditions, you may have a higher risk of breast cancer. There are several types of benign breast conditions that affect breast cancer risk:
Excessive growth of normal-looking cells: Doctors call this "proliferative lesions without atypia." In these conditions, cells in the ducts (the pipes of the breast that drain the milk out to the nipple) or lobules (the parts of the breast that make milk) are growing faster than normal, but the cells look normal. Doctors call these conditions:

• ductal hyperplasia (without atypia)
• complex fibroadenoma
• sclerosing adenosis
• papilloma or papillomatosis
• radial scar

Being diagnosed with one of these conditions can double your breast cancer risk.
Excessive growth of abnormal-looking cells: Doctors call this "proliferative lesions with atypia." In these conditions, cells in the ducts or lobules are growing faster than normal and look abnormal. The specific conditions are:

• atypical ductal hyperplasia
• atypical lobular hyperplasia

Being diagnosed with one of these conditions can make your risk of breast cancer 4 to 5 times higher than normal. If you have one or both of these conditions along with a strong family history, your risk can be higher.
These are just a few steps you can take. Review the links on the left side of this page for more options.
Along with these lifestyle choices, there other risk-reduction options for women at high risk.
Hormonal therapy medicines: SERMs (selective estrogen receptor modulators) have been shown to reduce the risk of developing hormone-receptor-positive breast cancer in women at high risk. Tamoxifen and Evista (chemical name: raloxifene) are the two SERMs used in this way.

• Tamoxifen has been shown to reduce the risk of first-time hormone-receptor-positive breast cancer in both postmenopausal and premenopausal women at high risk. Certain medicines may interfere with tamoxifen's protective effects. Visit the tamoxifen page to learn more.
• Evista has been shown to reduce the risk of first-time hormone-receptor-positive breast cancer in postmenopausal women. Visit the Evista page for more information.

Hormonal therapy medicines do not reduce the risk of hormone-receptor-negative breast cancer.
Together, you and your doctor can decide if medicine to lower your risk is a good option for you.
More frequent screening: If you're at high risk because of a benign breast condition, you and your doctor will develop a screening plan tailored to your unique situation. Recommended screening guidelines include:

• a monthly breast self-exam
• a yearly breast exam by your doctor or nurse practitioner
• a mammogram every year starting at age 40

Your personal screening plan may involve screening before age 40. For example, if you were diagnosed with a benign breast condition at age 30, you and your doctor will decide when you should start having mammograms or other screening tests. Your personal screening plan also may include the following tests to detect any cancer as early as possible:

• MRI (magnetic resonance imaging) of the breast
• ultrasound

You may have these tests more often than a woman at average risk. So you might have one screening test -- a mammogram, say -- and then have a different test -- an MRI -- 6 months later. Before or after each screening test, your doctor may perform a breast exam.
Protective surgery: Removing one or both healthy breasts and ovaries -- called prophylactic surgery ("prophylactic" means "protective") -- are aggressive, irreversible risk-reduction options that some women with benign breast conditions may choose, whether or not they have other risk factors (an abnormal BRCA1 or BRCA2 gene, for example).
Prophylactic breast surgery may be able to reduce a woman's risk of developing breast cancer by as much as 97%. The surgery removes nearly all of the breast tissue, so there are very few breast cells left behind that could develop into a cancer.
Women with an abnormal BRCA1 or BRCA2 gene may reduce their risk of breast cancer by about 50% by having prophylactic ovary removal (oophorectomy) before menopause. Removing the ovaries lowers the risk of breast cancer because the ovaries are the main source of estrogen in a premenopausal woman's body. Removing the ovaries doesn't reduce the risk of breast cancer in postmenopausal women because fat and muscle tissue are the main producers of estrogen in these women. Prophylactic removal of both ovaries and fallopian tubes reduces the risk of ovarian cancer in women at any age, before or after menopause.
The benefit of prophylactic surgeries is usually counted one year at a time. That's why the younger you are at the time of surgery, the larger the potential benefit and the older you are, the lower the benefit. Also, as you get older you're more likely to develop other medical conditions that affect how long you live, such as diabetes and heart disease.
Of course, each woman's situation is unique. Talk to your doctor about your personal level of risk and how best to manage it.
It's important to remember that no procedure -- not even removing both healthy breasts and ovaries at a young age -- totally eliminates the risk of cancer. There is still a small risk that cancer can develop in the areas where the breasts used to be. Close follow-up is necessary, even after prophylactic surgery.
Prophylactic surgery decisions require a great deal of thought, patience, and discussion with your doctors, genetic counselor, and family over time -- together with a tremendous amount of courage. Take the time you need to consider these options and make decisions that feel comfortable to you.