Risk-reducing interventions

Risk-reducing interventions can be considered for patients with a high risk of breast and/or ovarian cancer. These can include:

• Prophylactic bilateral surgery, with self-surveillance advised in the future. Having both breast removed reduces the risk of breast cancer by 95%.
• Bilateral salpingo oophorectomy, with hormone replacement therapy used for five years’ post-surgery, if necessary. If performed at or by the age of 40, the risk of ovarian cancer is reduced by 98%, and the risk of breast cancer in pre-menopausal women is reduced by 50-60%.
• Surveillance, with annual mammograms and MRIs that are alternated so that one is performed every six months. The need for MRI may be reassessed after the age of 50. Annual clinical breast examinations are also recommended.
• Risk-reducing medication that blocks or reduces oestrogen in the body, such as Tamoxifen. This is more suited to high-risk women with BRCA2 mutations (BRCA1 cancers aren’t typically oestrogen sensitive), and requires an in-depth discussion with the patient’s breast specialist on potential side effects.

The Ministry of Health has complied guidelines for prophylactic treatment for high-risk patients. View the guidelines (under Special Issues section).

The following interventions are available for those with a moderate risk of breast cancer:

• Surveillance with clinical checks and regular imaging.
• Annual mammograms between 40-50, and two-yearly mammograms from 50 (or annually if breasts are very dense).
• Risk-reducing medication (Tamoxifen or anastrozole) could be considered.
• Risk-reducing surgery is not usually recommended for the moderate risk group, but patterns of family history and psychological factors are taken into consideration.

Women and men of all ages, and in all risk groups, must be aware of any breast changes and report them promptly.