Breast cancer risk reduction: what do we know and where should we go?

Clinicians should be aware of the advances in breast cancer risk assessment and risk-reduction therapy. The modified Gail model is appropriate for predicting the risk of developing breast cancer within the next 5 years for most women between ages 35 and 75. Tamoxifen has been approved by the U.S. Food and Drug Administration (FDA) for reduction of breast cancer risk in women aged 35 and older who meet the threshold risk for breast cancer. Raloxifene is being compared with tamoxifen in the clinical trial, STAR (a Study of Tamoxifen and Raloxifene), which is now enrolling postmenopausal women aged 35 or older. The risks and benefits of therapy to reduce breast cancer risk are reviewed here. Processes for comparison of risks and benefits and for shared decision making are outlined.