Importance of Early Detection and Prevention of Breast Cancer

While there is no precise way to prevent breast cancer, there are various lifestyle measures that may aid in reducing some of the modifiable risk factors associated with breast cancer. The American Cancer Society indicates that some risks of breast cancer can be reduced via diet, weight loss if needed and exercise. Patients should also discuss their overall risk including modifiable and non-modifiable risk factors (genetics/family history) with their primary health care provider. Monthly self-breast exams, annual clinical breast exams and annual mammograms are the most effective means of detecting breast cancer early. Research reveals that regular screening mammography starting at age 40 years diminishes breast cancer mortality in average-risk women.¹

Recent Developments in Prevention and Detection of Breast Cancer

• On October 12, 2021, the FDA granted premarket approval to the SoftVueTM 3D Whole Breast Ultrasound Tomography System (Delphinus Medical Technologies) for use as an adjunct to digital mammography in the screening of asymptomatic women with dense breast tissue.²  Clinical evidence has proven that SoftVue improves dense breast screening and recognizes up to 20% more cancers with greater accuracy and potentially fewer biopsies than full field digital mammography (FFDM) alone.²  More information can be found here. 
• Results from a study published in the Journal of the National Cancer Institute indicates that for women with extremely dense breast, screening with MRI alone every 4 years is cost-effective and delivers the greatest benefit.³
• In a commentary published in the Journal of Oncology Practice, researchers indicated that advances in the prevention of breast cancer have led to development of novel and innovative opportunities to alter breast cancer risks and potentially diminish incidence and mortality related to breast cancer. ^4,5 In an interview, Sandhya Pruthi, M.D., a Mayo Clinic internist and author of the commentary stated, “It is prudent for health care providers to be knowledgeable about the benefits of assessing individual breast cancer risk, and counsel and implement risk-reducing strategies with their patients.” She also noted that evidence-based, risk-reducing strategies include lifestyle modification, preventive anti-estrogen medications, surveillance breast imaging and genetic testing and women at elevated risk of harboring a hereditary breast cancer mutation should consider prophylactic surgery to decrease risk. ^4,5  She stated, “Physicians should be recommending individualized risk assessments for their patients and counseling them on interventions that range from lifestyle modifications to the use of preventive (anti-estrogen) medications or conjugated equine estrogen."  Dr. Pruthi also encouraged women and their health care providers to consider a comprehensive approach to breast cancer prevention that comprises risk assessment; awareness of modifiable lifestyle factors, including low-fat dietary interventions; and use of pharmacological agents that may decrease the risk of breast cancer mortality.  ^4,5
• In a presentation at the recent Northern American Menopause Society Annual Meeting in September, Dr. Lisa Larkin , MD, FACP, NCMP, IF, indicated that a comprehensive approach for treatment and prevention of breast cancer and collaborating with patients to diminish lifestyle risk may reduce rates of mortality. During the presentation, Dr. Larkin, founder and CEO of Ms.Medicine, stated, “Despite having very robust screening in our country with women getting annual mammography at a rate that’s higher than other developed countries, mortality for breast cancer in the United States is not lower than other countries.^6,7 She indicated that to improve outcomes, clinicians should focus on both non-modifiable and non-modifiable risk factors. Overall, Dr. Larkin stated that doctors should do more and concentrate on lifestyle early because there are limited opportunities to impact care among younger women.  Dr. Larkin noted, “We need to really be focusing on lifestyle and encouraging them to have ideal lifestyle behaviors. The goal is breast cancer prevention, not just early detection.”^6,7

Through ongoing research efforts and advancements in technology, increasing knowledge and availability of more screening tools, clinicians are able to improve clinical outcomes in the breast cancer patient population via early detection and treatment tailored to patient need. Since mammograms are effective tools that can aid in detecting breast cancer, it is imperative that women discuss these issues with their primary health care provider, especially if they have  genetic risks factors and/or other risk factors. Pharmacists are in a key position to enhance awareness about the detection, screening, and treatment of breast cancer. During patient counseling, pharmacists should seize every possible opportunity to encourage and remind their patients about the significance of regular breast cancer screening, including mammography, routine medical checkups, yearly clinical breast exams, and monthly self-breast exams which can be instrumental in identifying breast cancer early on.

References

1. Myers ER, Moorman P, Gierisch JM, Havrilesky LJ, Grimm LJ, Ghate S, et al. Benefits and harms of breast cancer screening: a systematic review [published erratum appears in JAMA 2016;315:1406]. JAMA 2015;314: 1615–34.
2. Delphinus receives FDA approval for its SoftVue 3D Whole Breast Ultrasound Tomography System. News release. October 12, 2021. https://www.businesswire.com/news/home/20211012005417/en/Delphinus-Receives-FDA-Approval-for-its-SoftVue-3D-Whole-Breast-Ultrasound-Tomography-System.
3. Geuzinge HA, Bakker MF, Heijnsdijk EAM, van Ravesteyn NT, Veldhuis WB, Pijnappel RM, de Lange SV, Emaus MJ, Mann RM, Monninkhof EM, de Koekkoek-Doll PK, van Gils CH, de Koning HJ. Cost-Effectiveness of Magnetic Resonance Imaging Screening for Women With Extremely Dense Breast Tissue. J Natl Cancer Inst. 2021 Sep 29:djab119. doi: 10.1093/jnci/djab119. Epub ahead of print. PMID: 34585249.
4. Pruthi S, Mussallem DM, Cornell LF, Klassen CL, Kling JM. Reducing Breast Cancer Incidence and Mortality: Rethinking an Approach to Risk Assessment and Prevention. JCO Oncol Pract. 2021 Sep 7:OP2100551. doi: 10.1200/OP.21.00551. Epub ahead of print. PMID: 34491812.
5. Mayo Clinic researchers advocate new approach to breast cancer prevention. Mayo Clinic website. Published September 27, 2021. Accessed October 15, 2021. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-researchers-advocate-new-approach-to-breast-cancer-prevention/
6. Larkin L. Breast cancer risk assessment for women’s health clinicians. Presented at: North American Menopause Society Annual Meeting; Sept. 22-25, 2021; Washington, D.C.
7. Gawel R. Goal should be prevention, not just early detection’ when it comes to breast cancer. Healio website. Published October 4, 2021. Accessed October 15, 2021. https://www.healio.com/news/womens-health-ob-gyn/20211004/goal-should-be-prevention-not-just-early-detection-when-it-comes-to-breast-cancer