The Primary Prevention of Breast Cancer: Risk Assessment, Genetic Screening, Chemoprevention, and Modifiable Risk Factors

To reduce the morbidity and mortality associated with breast cancer, primary care providers must pay focused attention to prevention in all adult women. This chapter presents a risk stratification paradigm, starting with three basic questions, and usable tools to determine which women would benefit from risk-reducing interventions. Risk factors which are associated with a high risk of breast cancer include a history of chest radiation, a strong family history of cancer, a known genetic mutation, and a personal history of high-risk breast lesions. After risk assessment, preventive strategies are prescribed using a personalized prevention plan. Patients with an elevated risk are further evaluated and counseled, with consideration of early breast imaging with mammography and MRI, chemoprevention, specialty referral, or prophylactic surgery. The screening, counseling, treatment, and referral of all women according to breast cancer risk status by primary care providers will reduce the toll of preventable breast cancer morbidity and mortality.