Describe Breast cancer screening.
Women with first-degree relatives with breast cancer should begin screening 10 years before the age of the earliest diagnosis in the family.
Physical examination plays a minor role in screening for breast cancer.
Which individuals are considered as high risk?
Known BRCA mutation
First-degree relative with a BRCA mutation
Lifetime risk for breast cancer of about 20–25%
Women who have a family history of breast cancer
Women with a history of chest radiation therapy (between 10–30 years of age)
Women with a personal or family history of familial cancer syndromes (e.g., Li-Fraumeni syndrome, Cowden syndrome)
Women ≥ 35 years of age with previous invasive breast cancer or carcinoma in situ
Screening recommendations (table).
When is prophylactic surgery indicated?
Bilateral prophylactic mastectomy
Bilateral salpingo-oophorectomy (BSO) by age 35–40 years and/or when childbearing is no longer desired
What is an alternative to prophylactic surgery as prevention measures for high-risk individuals?
chemoprevention with selective estrogen receptor modulator
In high-risk premenopausal women: tamoxifen
In high-risk postmenopausal women
Tamoxifen or raloxifene
Aromatase inhibitors (e.g., anastrozole, exemestane): monotherapy or in sequence with SERM
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