A woman's breast cancer risk should be formally assessed using a validated risk prediction tool such as BOADICEA, Tyrer Cuzick (ems-trials.org/riskevaluator/) or iPrevent (petermac.org/iprevent).
Based on the population evidence, there has been a shift towards breast awareness (vigilance towards own breast changes) in lieu of routine breast self-examination (BSE). A meta-analysis reported no reduction in mortality in women who detected their cancers during BSE; and no difference in mortality between women who received training for BSE compared with those who did not receive training.r In the same study, BSE was associated with considerably more women seeking medical advice and having biopsies.
A large single-arm prospective study of moderate-risk women aged 40–49 years showed that annual mammography is both cost effective and clinically effective in reducing breast cancer predicted mortality.r This study also showed that the false-positive rates and associated radiation exposure were similar to those in the National Breast Screening Programme.r For women with heterogeneous dense and dense breast tissue, supplemental screening should be considered as dense breasts limit the sensitivity of mammograms and dense breasts are independently associated with an increased risk of breast cancer.r
Selective oestrogen receptor modulators (SERM), such as tamoxifen and raloxifene, have been shown to reduce the risk of oestrogen receptor-positive breast cancer in women identified to be at increased risk. In a meta-analysis, SERM reduced breast cancer incidence by 38% (HR 0.62 with 95% CI, 0.56–0.69) compared with placebo in women at increased risk,r and the risk reduction associated with tamoxifen use extended beyond the treatment period.r See COSA medication to lower the risk of breast cancer: clinician guide.
Modifiable risk factors for breast cancer
For a summary of the evidence for modifiable lifestyle risk factors for breast cancer, see Cancer Australia “Breast cancer risk factors: a review of the evidence.” These recommendations apply to the general population; there is no specific evidence for the moderate-risk group.