Stopping Breast Cancer Before It Starts

If you knew you were at high risk for developing breast cancer and there were steps you could take to prevent it, would you?

After skin cancers, breast cancer is the most common cancer and the second leading cause of cancer death in women in the United States. About one in eight women will develop breast cancer in her lifetime. The average age at diagnosis is 62. For many women who are at higher than average risk, chemoprevention is an option.

Chemoprevention agents are medicines that can inhibit or slow the growth of cancer cells. General surgeon Mike Ratliff, MD, who is affiliated with Memorial Hermann Greater Heights Hospital, says the term “chemoprevention” is a misnomer. “When women think of ‘chemo’, they envision an IV drip and significant side effects, such as vomiting and hair loss. This is not that,” he says. “More accurately called endocrine therapy, it is, for the most part, very well tolerated. It’s like taking a vitamin once a day.”

Factors that increase a women’s risk of developing breast cancer include a personal history of breast cancer, her age, a family history of breast cancer, a longer menstrual history or a genetic mutation linked to a family cancer syndrome, such as a BRCA mutation.

Additionally, among the women for whom chemoprevention might be an option are those who have been diagnosed with a precancerous condition that affect the cells in the breast, including atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS).

Despite the proven benefits of chemoprevention, however, many women who might benefit are unaware of this potentially lifesaving option. As Dr. Ratliff observes, “It is imperative and incumbent on all of us as physicians— surgeons, family doctors, OB/GYNs and certainly medical oncologists—to make women aware of this option—to avail them of this option—because we know for a fact it works. The benefit is real.”

The U.S. Preventive Services Task Force (USPSTF), an independent, volunteer panel of national experts in disease prevention and evidence-based medicine, recommends that clinicians offer to prescribe risk-reducing medications to women aged 35 years or older who are at increased risk for breast cancer, and at low risk for adverse medication effects.

Once a woman has been identified as being at higher-than-average risk, a medical oncologist can work with her to accurately quantify her risk and help her weigh the benefits of chemoprevention against potential side effects. The affiliated cancer specialists at Memorial Hermann—oncologists, radiologists, surgeons and others— meet regularly to design the best care plan for each patient.

Dr. Ratliff, who leads these meetings (called tumor boards) at Memorial Hermann Greater Heights, says by reviewing a patient’s case in this fashion, the patient benefits from the collective expertise of the team. Among the factors considered in reviewing a patient’s case are the guidelines set forth by the National Comprehensive Cancer Network (NCCN).

This method of case presentation and multidisciplinary, collaborative approach is one reason why Memorial Hermann Cancer Center – Greater Heights, along with the seven other Memorial Hermann Cancer Centers, is accredited by the American College of Surgeons Commission on Cancer (ACoS CoC). Also, they are also one of the reasons why Memorial Hermann Cancer Center – Greater Heights is also accredited by the National Accreditation Program for Breast Centers (NAPBC), a consortium of national, professional organizations dedicated to the quality of care of patients with diseases of the breast.

“Part of the rigorous evaluation by these national accreditation organizations regards how we care for our patients,” says Ratliff. “It’s another tool we use to give our patients the best care possible.”