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REDUCING BREAST CANCER RISK IN WOMEN Developments in Oncology Volume 75 The titles published in this series are listed at the end of this volume. REDUCING BREAST CANCER RISK IN WOMEN Edited by BASLI A. STOLL Honorary Consulting Physician to Oncology Department, St. Thomas' Hospital, London; Consultant to Joint Breast Clinic, Royal Free Hospital, London, UK Introduced by SUSAN M. LOVE Director UCLA Breast Center; Associate Professor of Clinical Surgery, University of California at Los Angeles School of Medicine, California, USA SPRINGER SCIENCE+BUSINESS MEDIA, B.V. Library of Congress Cataloging-in-Publication Data Reducing breas t cance r ris k ; ;n warnen / edite d b y Basi l A. Stol l ; introductio n b y Susan M. Love . p. cm . — (Developments i n oncology ; 75) Iocludes index . ISBN 978-94-010-4219-2 ISBN 978-94-011-0489-0 (eBook) DOI 10.1007/978-94-011-0489-0 1. Breast—Cancer—Prevention . 2 . Breast—Cancer—Ris k factors . I. Stoll , Basi l A. (Basi l Arnold ) II . Series. [DIMLM: 1. Breast Neoplasms—preventio n & control . 2 . Ris k Factors. W 1 DE998N v. 75 1995 7 WP 87 0 R321 1995 ] RC280.B8R462 199 5 616.99'449052—dc20 DNLM/DCL fo f Congres 94-2939 r Librar y o s 4 ISBN 978-94-010-4219-2 Printed on acid-free paper All Rights Reserved © 1995 Springer Science+Business Media Dordrecht Originally published by Kluwer Academic Publishers in 1995 Softcover reprint of the hardcover 1st edition 1995 No part of the material protected by this copyright notice may be reproduced or utilized In any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without written permission from the copyright owner. This book is dedicated to The courageous smiles of our patients Contents Preface ix List of Contributors xi Introduction by Susan M. Love xv Part One: Recognizing Increased Breast Cancer Risk Chapter 1. Who Develops Breast Cancer? 3 Basil A. Stoll Chapter 2. Risk from Family History 11 Basil A. Stoll Chapter 3. Childbearing and Related Risk Factors 19 Basil A. Stoll Chapter 4. Risk from Benign Breast Disease 29 Basil A. Stoll Chapter 5. Risk from Age, Race and Social Class 41 Marianne Ewertz Chapter 6. Assessing a Woman's Genetic Risk 47 David E. Goldgar and Constance M. Goldgar Chapter 7. Ethics and Economics of Genetic Testing for Breast Cancer 55 Robert A. Hiatt Part Two: Advising the High-Risk Woman Chapter 8. Counseling the High-Risk Woman 69 Victor G. Vogel Chapter 9. Mastectomy for Cancer Prevention 81 Mary Jane Houlihan and Robert M. Goldwyn Chapter 10. Trial of Tamoxifen Therapy for Protection 91 Basil A. Stoll Chapter 11. Trial of Vitamin A Analogues for Protection 103 Alberto Costa, Franca Formelli, Rosalba Torrisi and Andrea Decensi Chapter 12. Trial of Low Fat Diet for Protection 109 Rowan T. Chlebowski vii viii Contents Chapter 13. Trial of Ovarian Suppression for Protection 119 Darcy V. Spicer, Elizabeth A. Krecker and Malcolm C. Pike Chapter 14. Compliance by High-Risk Women 125 Henry T. Lynch, Jane F. Lynch and Theresa Conway Part Three: Avoidance of Possible Risk Factors Chapter 15. Dietary Guidelines 135 Michelle D. Holmes, David J. Hunter and Walter C. Willett Chapter 16. Risks Associated with Obesity 145 Kathy L. Radimer and Christopher Bain Chapter 17. Choosing Hormonal Contraception 155 Kathryn F. McGonigle and George R. Huggins Chapter 18. Choosing Hormone Replacement Theory 165 Richard L. Theriault, Laura L. Boehnke and Rena V. Sellin Chapter 19. Clinical Programs for Breast Cancer Protection 177 Maureen M. Henderson and Anne McTiernan Chapter 20. Nurses' Role in Educating Women on Risks 185 Nina Entrekin and Lisa Summerlot Part Four: Perspectives and Viewpoints Chapter 21. Women's Perspectives on Breast Cancer Protection 195 Jeanmarie Marshall Chapter 22. A Patient's View of Breast Cancer Trials 205 Hazel Thornton Chapter 23. Should We Aim at Prevention in Youth? 209 A. Lindsay Frazier and Graham A. Colditz Chapter 24. Role and Limitations of Mammography in Screening 217 Anthony B. Miller Chapter 25. The Mind and Breast Cancer Risk 223 Beth Leedham and Beth E. Meyerowitz Chapter 26. Avoidable Environmental Links to Breast Cancer 231 Devra Lee Davis and H. Leon Bradlow Chapter 27. Asking the Right Questions 237 Basil A. Stoll Index 243 Preface This book is aimed particularly at primary health-care professionals including physicians, medical assistants, nurses and counselors. They are in the front line, answering questions daily from women concerned about their risk of developing breast cancer. Not only is the problem a burning public issue, but very soon we shall see genetic testing for a woman's predisposition to breast cancer. Many close relatives of breast cancer patients will be pressing to know their degree of risk and will need counseling to cope with that information. If they are aware of recent public discussion on the safety of agents on trial for breast cancer prevention, they will be looking for information on all possible options. To answer such questions, this book has combined a guide to identifying women at increased risk to breast cancer with a balanced review of approaches which aim to reduce that risk. As it is a practical handbook, technicalities have been deliberately kept to a minimum, making the book concise and easy to read. The first section of the book provides an update on the major clinical, micro scopic, family history and genetic criteria used to identify a woman at increased risk, and how these characteristics are combined for risk assessment. The second section sets out the preventive options which are being used or tested, their ratio nale, possible benefits and disadvantages. The third section evaluates suspected or minor risk factors, and examines lifestyle or personal habits which may affect a woman's risk of developing breast cancer. The final section offers personal views on specific aspects of breast cancer control. The book is patient-centered and is not intended to be an exhaustive or aca demic study of past research or current hypotheses. It aims to provide a balanced perspective on the state-of-the-art. For a woman who is at clearly increased risk, the book discusses different protection options with different levels of efficacy and acceptability. For the woman at average risk, the book offers a guide to practical general measures which may reduce her risk, particularly in avoiding substances which are believed to increase breast cancer risk. Slight overlap between sections ensures that each is complete in itself. Inexact knowledge is responsible for the different criteria used in selecting women for preventive trials. More serious, however, is that clinicians differ also in their attitudes to discussing protective options with a woman who is clearly at increased risk. Many experts tell her that they are unable to suggest a method which is both effective and safe, and advise her to join any trial for which she is eligible. We need to face up to the situation that it will be many years before the current clinical trials of preventive measures provide meaningful results. Meanwhile, the woman who seeks to decrease her risk of breast cancer needs all the available information and time to digest it. She must be given full responsibility to make ix x Preface an informed decision on her own health care and deserves understanding and counseling, because patients' perspectives are not necessarily the same as those of their clinicians. London, 1995 Basil A. Stoll List of Contributors Christopher Bain, MB BS, MPH Andrea Decensi, MD Reader Department of Medical Oncology Department of Social and Preventive Medicine National Institute for Cancer Research University of Queensland Genoa Australia Italy Laura Boehnke, Pharm D Nina Entrekin, RN, MN, OCN Clinical Pharmacy Specialist Director MD Anderson Cancer Center Breast Cancer Program Development Houston, Texas American Cancer Society USA Florida Division Inc. Tampa, Florida H. Leon Bradlow, PhD USA Strang-Cornell Medical Center New York Marianne Ewertz, MD, Dr. Med. Sci. USA Danish Cancer Society Division of Cancer Epidemiology Rowan T. Chlebowski, MD, PhD Copenhagen Professor of Medicine Denmark Associate Chief Division of Medical Oncology Franca Formelli, PhD Harbor-UCLA Medical Center Division of Experimental Oncology B Torrance, California Istituto N azionale Tumori USA Milan Italy Graham A. Colditz, MB BS, Dr PH Channing Laboratory A. Lindsay Frazier, MD, MSc Department of Medicine Department of Pediatric Hematology Brigham and Women's Hospital Dana Farber Cancer Institute and Harvard Medical School and Harvard Medical School Boston, Massachusetts Boston, Massachusetts USA USA Theresa Conway, BSN, RN Constance M. Goldgar, MS Department of Preventive Medicine and Public Health Genetic Epidemiology Group Creighton University University of Utah School of Medicine Salt Lake City, Utah Omaha, Nebraska USA USA David E. Goldgar, PhD Alberto Costa, MD Associate Professor Division of Senology Genetic Epidemiology Group Istituto Europeo di Oncologia Department of Medical Informatics Milan University of Utah Italy Salt Lake City, Utah USA Devra Lee Davis, PhD, MPH Office of the Assistant Secretary for Health Robert M. Goldwyn, MD US Department of Health and Human Services Clinical Professor of Surgery Washington, DC Harvard Medical School USA Chief, Division of Plastic Surgery xi