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 no receive training.r In the same study, BSE was associated with considerably more women seeking medical advice and having biopsies.
While there is some evidence that BSE may be beneficial for detecting breast cancer in high-risk women,r little data is available for BSE in the moderate-risk group.
Randomised trials of mammographic surveillance compared with no surveillance in moderate-risk women are unlikely to be ethically feasible. 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 their National Breast Screening Programme.r The present recommendations also reflect the current United Kingdom consensus guidelines (NICE Guidelines CG164, Published June 2013).
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 Cancer Australia Risk-reducing medication resource.
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.