MIAMI BEACH, FloridaThe Breast Cancer Risk Assessment Working Group is completing work on its consensus guidelines for stratifying patients into risk categories for breast cancer and managing their care accordingly. The model was outlined at the 19th Annual Miami Breast Cancer Conference.
The Risk Assessment Working Group
"This ongoing effort aims to marry evidence-based medicine with a pragmatic approach, to spur further clinical research and to help practitioners manage these high-risk women," said founding member Joyce O’Shaughnessy, MD, Baylor-Sammons Cancer Center/US Oncology, Dallas. The new guidelines, for example, suggest the use of ductal lavage to look for atypical cells as a pragmatic tool to help high-risk women make decisions regarding chemoprevention.
Although accurate tools to assess breast cancer risk have been available for some time, the Working Group effort is perhaps the first to suggest specific risk reduction strategies based on a woman’s risk assessment. "Because we now have interventions, such as tamoxifen(Drug information on tamoxifen) [Nolvadex], with many others coming down the pike, it’s really time to identify women who might benefit from these interventions," Dr. O’Shaughnessy said.
The Working Group’s chair, Victor Vogel, MD, director of the Magee-Women’s Hospital/University of Pittsburgh Cancer Institute Breast Program, recommended obtaining software for the Gail or Claus assessment models or accessing the National Cancer Institute’s assessment tool at http://bcra.nci.nih.gov/brc/.
For women who are at average risk, the group recommends an annual clinical breast examination, annual mammography starting at age 40, and a reassessment of risk every 2 to 3 years.
The elevated/high-risk group is comprised of women who have atypical ductal or lobular hyperplasia or cellular atypia, a 5-year risk of 1.7% or more on the Gail index, and/or two or more second-degree relatives who developed breast cancer before menopause. Women who have used estrogen-progesterone replacement therapy for 10 years or more are also in this group because of evidence that this therapy increases risk by 5% for each year it is taken.