Download - Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer
![Page 1: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/1.jpg)
Epidemiology, genetics, and risk evaluation of
postmenopausal womenat risk of breast cancer
Menopause: The Journal of The North American Menopause Society
Vol. 15, No. 4, pp. 782/789Jul-Aug, 2008
![Page 2: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/2.jpg)
![Page 3: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/3.jpg)
Classic Breast Cancer Risk Factors
All women are at risk of breast cancer, and the single most important risk factor is age.
![Page 4: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/4.jpg)
![Page 5: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/5.jpg)
(in the child)
![Page 6: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/6.jpg)
Sclerosing adenosis increases the risk of breast cancer byapproximately 70%.
![Page 7: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/7.jpg)
5% to 10% of proliferative lesions show cellular atypia,which increases the risk of breast cancer fivefold.
Nearly 40% of women with a family history of breast cancer and atypical hyperplasia subsequently develop breast cancer.
![Page 8: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/8.jpg)
LCIS (lobular carcinoma in situ) has generally been considered a risk indicator, conferringan increased rate of development of invasive carcinoma of approximately 1% to 2% per year, with a lifetime risk of 30% to 40%.
![Page 9: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/9.jpg)
FAMILY HISTORY OF BREAST CANCERAND BRCA1 AND BRCA2 MUTATIONS
• Genetic factors contribute to approximately 5% of all breast cancers, but to 25% of cases diagnosed before 30 years of age.
• Having more relatives with breast cancer before age 50 increases the cumulative lifetime risk of developing the disease to almost 50%
• The risk of breast cancer associated with either a BRCA1 or BRCA2 mutation is more than 200 times greater in individuals younger than age 40 but drops to 15-fold in the seventh decade of life.
• High-grade DCIS is more common in BRCA1 mutation carriers than in patients without a mutation
![Page 10: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/10.jpg)
MAMMOGRAPHIC DENSITY AND
CIRCULATING ENDOGENOUS HORMONE LEVELS
• Levels of both circulating sex steroids and mammographic density are significantly and independently associated with breast cancer risk.
• High mammographic density on a first examination is associated with a high rate of breast cancer that remains high even if breast density decreases in subsequent mammographic examinations.
• Increased risk with elevated total estradiol, free estradiol, non-SHBG-bound estradiol (which comprises free and albumin-bound estradiol), estrone, estrone sulfate, androstenedione, DHEA, DHEA-S, and testosterone.
![Page 11: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/11.jpg)
![Page 12: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/12.jpg)
IMPACT OF DIET, EXERCISE,AND ENVIRONMENTAL FACTORS
• Excess weight and weight gain in adult life are related to higher risk of postmenopausal breast cancer.
• Weight loss after menopause is associated with substantially reduced risk.
• Physical activity and the prevention of weight gain can improve survival after a breast cancer diagnosis.
• The only well-established individual diet-related risk factorfor breast cancer other than obesity is alcohol consumption.
• Populations with high fat intakes generally have higher rates of breast cancer, but studies of individual women have not confirmed an association of high-fat diets with breast cancer risk.
• Folic acid: dual effect?• Phytoestrogen: inconsistent.
![Page 13: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/13.jpg)
QUANTITATIVE RISK ASSESSMENTAND THE GAIL MODEL
• The average age at diagnosis of breast cancer among women in North America is 60 years, and the risk of developing breast cancer among these women is 1.67% in the 5 years between ages 60 and 65.
• Women whose 5-year risk of developing invasive breast cancer is greater than 1.67% are considered to be at increased risk.
• FDA used this risk level to define high-risk subjects who might consider the use of selective estrogen receptor modulators (tamoxifene or raloxifene) for reduction of breast cancer risk.
![Page 14: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/14.jpg)
![Page 15: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/15.jpg)
![Page 16: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/16.jpg)
![Page 17: Epidemiology, genetics, and risk evaluation of postmenopausal women at risk of breast cancer](https://reader035.vdocuments.net/reader035/viewer/2022070410/5681455d550346895db22f26/html5/thumbnails/17.jpg)