Breast Cancer Prevention Puzzels

Tamoxifen has moved from a treatment of breast cancer, to a prevention strategy for high risk women. Given that only 1-5 breast cancers are thought to be genetic, it's not actually a practical strategy of prevention for most women who will get breast cancer. None the less, it can reduce estrogen receptor positive breast cancer by about 50% if used for at least 5 years. The biggest puzzle is what to do for the complications women are at risk for them. For instance we know that there is almost a 4 times greater risk of lining cancer of the uterus (endometrial cancer) in women who are both over 50 and using the medication for breast cancer prevention. We have figured out that if a woman already has a polyp in the endometrium or the lining before the medicine is given for cancer prevention the likelihood of complication is greater. Although not yet studied, it's intriguing to think that women with prior endometrial ablations might have a significantly reduced risk of lining complications. It's the old problem, kind of rubric puzzle like...just when you get a line of color exactly like you wanted, it knocks something else out of whack. So think carefully about the risk benefit ratio of all therapies!

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