Options for women with a high risk of developing breast cancer

Risk reducing breast cancer is one way of managing a high risk of breast cancer. But, there are others. Each option has benefits and disadvantages. Your specialist team can talk these through with you.

  • Breast screening – Having regular breast x-rays and breast scans can help to detect breast cancer at an early stage when it is often curable. Breast screening can’t prevent breast cancer.
  • Taking drugs to prevent breast cancer – Some drugs can help reduce the risk of breast cancer in some women. This is called chemoprevention. The most common drugs are tamoxifen and raloxifene.
  • Surgery to remove the ovaries and fallopian tubes – Women with the BRCA1 or BRCA2 faulty genes have an increased risk of ovarian and breast cancer. Having an operation to remove the ovaries and fallopian tubes reduces the risk of both cancers. The operation causes infertility so it is only done after a woman has completed her family.

Many women choose to make changes to their lifestyle to minimise their risk of breast cancer. This can include stopping smoking, drinking less alcohol, eating well and doing exercise.

Other options for managing a high risk of breast cancer

Risk-reducing breast surgery isn’t suitable for everyone. It may not be possible if you have health conditions that would increase the risk of an operation, such as a heart problem. There are other options for managing a high risk of breast cancer that can be used instead of or as well as risk-reducing breast surgery.

Regular breast screening

Regular breast screening cannot prevent breast cancer. But it can help find it at an early stage, when many breast cancers can be cured. For most women at a high risk of breast cancer, breast screening involves having a combination of yearly MRI scans (magnetic resonance imaging scans) and mammograms

If you are at a high risk of breast cancer, you usually have MRI scans yearly between the ages of 30–49. Some women have MRI scans between the ages of 25–49. After the age of 50, women at a high risk of breast cancer who have dense breast tissue continue to have yearly MRI scans.

Most women at high risk are also offered yearly mammograms (breast x-rays) between the ages of 40–69. Some women have mammograms between the ages of 35–69.

Taking drugs to reduce the risk of breast cancer

This is called chemoprevention and involves taking a tablet every day for five years. It can reduce the risk of a common type of breast cancer called oestrogen receptor-positive (ER+ve) breast cancer. For some women, this can reduce the risk of getting breast cancer by 30–40%.

The two drugs most commonly used are tamoxifen and raloxifene. Other drugs that may be used include anastrozole and exemestane.

Women can take tamoxifen before or after the menopause. But it’s not suitable for women who are trying to get pregnant. You need to use contraception while you are taking it.

Raloxifene, anastrozole and exemestane can only be used by women after the menopause.

Side effects of chemoprevention

The most common side effects are menopausal symptoms. These can include hot flushes, vaginal discharge and dryness, urinary problems and weight gain.

Tamoxifen can also cause a small increase in the risk of womb cancer and blood clots. These problems are more common in women who take tamoxifen after the menopause.

Anastrozole and exemestane can cause bone thinning and increase the risk of osteoporosis. Tamoxifen can also have this effect when taken before the menopause.

Women with a BRCA1 gene change don’t generally get ER+ve breast cancer. So if you have a BRCA1 gene change, chemoprevention may not be as effective. Current evidence is based on very small numbers so this is still an area of uncertainty.

Removal of the ovaries and fallopian tubes

This operation is called risk-reducing bilateral salpingo-oophorectomy. It may be offered to some women as well as risk-reducing breast surgery rather than instead of it.

Women who inherit a BRCA1 or BRCA2 gene change have a higher risk of getting both ovarian and breast cancer.

Removing the ovaries and fallopian tubes greatly reduces the risk of ovarian cancer. It may also reduce the risk of breast cancer.

This operation will make you infertile, so it can’t be done until after you have completed your family if you want children. Most women having this surgery have it done after the age of 35 and before the menopause.

After surgery, you usually take hormone replacement therapy (HRT) until the age you would expect to have the menopause.

This protects your bone and heart health, and prevents menopausal symptoms. In this situation, HRT doesn’t increase the risk of breast cancer.

Making positive choices

However you choose to reduce your risk of breast cancer, you may want to make positive lifestyle changes to improve your health. These include:

  • eating well
  • keeping to a healthy weight
  • being physically active
  • sticking to alcohol drinking guidelines
  • stopping smoking.

You can get advice on maintaining a healthy lifestyle from your GP, cancer specialist or specialist nurse.

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