Current Topics in Menopause

Assessing and Managing the Risk of Breast Cancer in Postmenopausal Women: Opportunities and Challenges

Author(s): Victor G. Vogel

Pp: 213-253 (41)

DOI: 10.2174/9781608054534113010012

* (Excluding Mailing and Handling)

Abstract

A number of factors are known to increase the risk of developing breast cancer. The most important of these is age, but race and ethnicity are associated with important differences in risk. Nulliparity and birth events, benign breast disease, and the use of replacement hormonal therapy at menopause also contribute to risk. Family history and the presence of predisposing genetic mutations are important factors as is ethanol consumption. Circulating estrogen levels can stratify risk, but their use in clinical settings is not routine. Risk for breast cancer can be easily and rapidly assessed in the clinic, and validated, quantitative models are available to accomplish this task. Mammographic breast density identifies postmenopausal women who are at increased risk. Multiple, published, randomized studies show that the selective estrogen response modifiers (SERMs) tamoxifen and raloxifene can safely reduce the risk of invasive breast cancer in both preand postmenopausal women. Tamoxifen provides net benefit to all premenopausal women who are at increased risk while raloxifene reduces risk nearly as much in postmenopausal women and offers increased safety. Both tamoxifen and raloxifene reduce both the incidence of in situ cancers and bone fractures. Women with a history of benign breast disease and a family history of invasive breast cancer in first-degree relatives and women with lobular carcinoma in situ derive substantial net benefit when using SERMs for breast cancer risk reduction. Of the 50 million white women in the U.S. aged 35 to 79 years, 2.4 million would have a positive benefit/risk index for chemoprevention.


Keywords: Quantitative Risk Assessment; Risk Reduction; Primary Prevention; Selective Estrogen Response Modifiers; Tamoxifen, Raloxifene.

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      • 11. app/Models/ContentAccess.php:647
      • 12. app/Http/Controllers/ChapterController.php:1478
      • 13. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
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      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1518
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 60104056 and j.to_ip >=60104056 )) and ((j.from_date <= 1740676812 and j.to_date >= 1740676812 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4799) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 60104056 and j.to_ip >=60104056 )) and ((j.from_date <= 1740676812 and j.to_date >= 1740676812 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4799) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 60104056 and j.to_ip >=60104056 )) and ((j.from_date <= 1740676812 and j.to_date >= 1740676812 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 4799)
      870μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 1177 and `b`.`banner_from_date` <= 1740676812 and `b`.`banner_to_date` >= 1740676812 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.55msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 1177
      • 3: 1740676812
      • 4: 1740676812
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='a1135e2816d5c113ab79ea6810557565'
      2.09msalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    2Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        x2SMudWGDcsDvwzaNryfpi9VeGFILtI7CKItG5VW
        uc_cart_id
        a1135e2816d5c113ab79ea6810557565
        _previous
        array:1 [ "url" => "http://alpha.eurekaselect.com/chapter/4799" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/4799
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
        array:8 [ "accept-encoding" => array:1 [ 0 => "gzip, deflate" ] "accept" => array:1 [ 0 => "text/html,application/xhtml+xml,application/xml;q=0.9,image/avif,image/webp,image/apng,*/*;q=0.8,application/signed-exchange;v=b3;q=0.7" ] "user-agent" => array:1 [ 0 => "Mozilla/5.0 AppleWebKit/537.36 (KHTML, like Gecko; compatible; ClaudeBot/1.0; +claudebot@anthropic.com)" ] "upgrade-insecure-requests" => array:1 [ 0 => "1" ] "cache-control" => array:1 [ 0 => "no-cache" ] "pragma" => array:1 [ 0 => "no-cache" ] "connection" => array:1 [ 0 => "keep-alive" ] "host" => array:1 [ 0 => "alpha.eurekaselect.com" ] ]
        request_cookies
        []
        
        response_headers
        0 of 0
        array:5 [ "content-type" => array:1 [ 0 => "text/html; charset=UTF-8" ] "cache-control" => array:1 [ 0 => "no-cache, private" ] "date" => array:1 [ 0 => "Thu, 27 Feb 2025 17:20:12 GMT" ] "set-cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6InE2a2VrOTZVUmZsYTl6S2R6dnhCNHc9PSIsInZhbHVlIjoic1RSR1l1WlBiUU5UUlQ3YmhDUXo4QXRKcDVLbm5SdXdUcnMxdHcrRW9oTllsdkpVOFFzSEZzR2xySVRRbisvelBaSFNDQnJCMkxpY2IyTEpGSHlHMFIrYW1yWWVXM1B1REVKSUxQMFpLVWo4TmUvb3dtemVwT2lwTmJhTndsbWIiLCJtYWMiOiJmNmNlN2RlZjk1NGM5YzhmOTFjOGY4NTRmMDFkNTc5YmZmMGI2YTNjZThjZDU4MjBmYTNiYTg4YWFjMTNlOTZhIiwidGFnIjoiIn0%3D; expires=Sun, 02 Mar 2025 05:20:12 GMT; Max-Age=216000; path=/; secure; samesite=laxXSRF-TOKEN=eyJpdiI6InE2a2VrOTZVUmZsYTl6S2R6dnhCNHc9PSIsInZhbHVlIjoic1RSR1l1WlBiUU5UUlQ3YmhDUXo4QXRKcDVLbm5SdXdUcnMxdHcrRW9oTllsdkpVOFFzSEZzR2xySVRRbisvelBaSFNDQ" 1 => "alphaeurekaselectnet_session=eyJpdiI6Imlnek40TGY4RFoyNllnbWtTbHhHVkE9PSIsInZhbHVlIjoiNzZ4d29oZTJoZ1JzZU5vZTlVVXZ0cEMzYUVNUzZwcGJyU0pDZTZHNTU4Wm0ycmxhZHl5RmdvaGZ6WlRXRW4wY1dGMVhrNXEwa28yYlZiYjA1WlFkRG8xT0duMVRrODIyRVJ0SjgrSEtXWi9nR05uME9jMHFGYlB3Qld3eEsyanYiLCJtYWMiOiI1OTA4MWE3NDI3ZGE1ZDU0NmYzOWQ5YjA0YTllYTg5NDU3NTkzNjA2YjE2NmY1NDE0MmJhZWEyNTYwNzg4NWYxIiwidGFnIjoiIn0%3D; path=/; secure; httponly; samesite=laxalphaeurekaselectnet_session=eyJpdiI6Imlnek40TGY4RFoyNllnbWtTbHhHVkE9PSIsInZhbHVlIjoiNzZ4d29oZTJoZ1JzZU5vZTlVVXZ0cEMzYUVNUzZwcGJyU0pDZTZHNTU4Wm0ycmxhZHl5RmdvaGZ" ] "Set-Cookie" => array:2 [ 0 => "XSRF-TOKEN=eyJpdiI6InE2a2VrOTZVUmZsYTl6S2R6dnhCNHc9PSIsInZhbHVlIjoic1RSR1l1WlBiUU5UUlQ3YmhDUXo4QXRKcDVLbm5SdXdUcnMxdHcrRW9oTllsdkpVOFFzSEZzR2xySVRRbisvelBaSFNDQnJCMkxpY2IyTEpGSHlHMFIrYW1yWWVXM1B1REVKSUxQMFpLVWo4TmUvb3dtemVwT2lwTmJhTndsbWIiLCJtYWMiOiJmNmNlN2RlZjk1NGM5YzhmOTFjOGY4NTRmMDFkNTc5YmZmMGI2YTNjZThjZDU4MjBmYTNiYTg4YWFjMTNlOTZhIiwidGFnIjoiIn0%3D; expires=Sun, 02-Mar-2025 05:20:12 GMT; path=/; secureXSRF-TOKEN=eyJpdiI6InE2a2VrOTZVUmZsYTl6S2R6dnhCNHc9PSIsInZhbHVlIjoic1RSR1l1WlBiUU5UUlQ3YmhDUXo4QXRKcDVLbm5SdXdUcnMxdHcrRW9oTllsdkpVOFFzSEZzR2xySVRRbisvelBaSFNDQ" 1 => "alphaeurekaselectnet_session=eyJpdiI6Imlnek40TGY4RFoyNllnbWtTbHhHVkE9PSIsInZhbHVlIjoiNzZ4d29oZTJoZ1JzZU5vZTlVVXZ0cEMzYUVNUzZwcGJyU0pDZTZHNTU4Wm0ycmxhZHl5RmdvaGZ6WlRXRW4wY1dGMVhrNXEwa28yYlZiYjA1WlFkRG8xT0duMVRrODIyRVJ0SjgrSEtXWi9nR05uME9jMHFGYlB3Qld3eEsyanYiLCJtYWMiOiI1OTA4MWE3NDI3ZGE1ZDU0NmYzOWQ5YjA0YTllYTg5NDU3NTkzNjA2YjE2NmY1NDE0MmJhZWEyNTYwNzg4NWYxIiwidGFnIjoiIn0%3D; path=/; secure; httponlyalphaeurekaselectnet_session=eyJpdiI6Imlnek40TGY4RFoyNllnbWtTbHhHVkE9PSIsInZhbHVlIjoiNzZ4d29oZTJoZ1JzZU5vZTlVVXZ0cEMzYUVNUzZwcGJyU0pDZTZHNTU4Wm0ycmxhZHl5RmdvaGZ" ] ]
        session_attributes
        0 of 0
        array:5 [ "_token" => "x2SMudWGDcsDvwzaNryfpi9VeGFILtI7CKItG5VW" "uc_cart_id" => "a1135e2816d5c113ab79ea6810557565" "_previous" => array:1 [ "url" => "http://alpha.eurekaselect.com/chapter/4799" ] "_flash" => array:2 [ "old" => [] "new" => [] ] "PHPDEBUGBAR_STACK_DATA" => [] ]
        ClearShow all
        Date ↕MethodURLData
        #12025-02-27 17:20:12GET/chapter/4799112194