Costa Mauricio, Saldanha Paula
Americas Medical City, Breast Center, Rio de Janeiro, Brazil.
Eur J Breast Health. 2017 Jul 1;13(3):103-112. doi: 10.5152/ejbh.2017.3583. eCollection 2017 Jul.
Evaluating the risk of breast cancer makes it possible to identify women with a high risk of developing breast cancer in the future. Adopting a healthier lifestyle, involving diet and exercise, is one way of reducing this risk-but there are other, non-modifiable risk factors, such as family history, genetics and diagnosis of premalignant lesions. In this high-risk population, the tracking must be rigorous and involve the participation of the patient herself, earlier and more frequent clinical assessment, and the use of imaging screening. Agents such as tamoxifen, raloxifene and aromatase inhibitors may be used in chemoprevention and may reduce the risk substantially. The risks and benefits must be assessed, and one must discuss with the patient her adverse events and the decision regarding the best treatment. Women who carry the BRCA1/2 mutation (very high risk) can benefit from prophylactic surgical interventions, such as bilateral mastectomy and/or bilateral salpingo-oophorectomy. This group of patients must be monitored by a multidisciplinary team, providing explanations prior to surgery regarding the surgical treatment offered, the reconstruction techniques, and the risks and complications.
评估乳腺癌风险有助于识别未来患乳腺癌风险较高的女性。采取更健康的生活方式，包括饮食和运动，是降低这种风险的一种方法——但还有其他不可改变的风险因素，如家族病史、基因以及癌前病变的诊断。在这个高风险人群中，追踪必须严格，且需要患者本人参与、更早且更频繁的临床评估以及使用影像学筛查。他莫昔芬、雷洛昔芬和芳香化酶抑制剂等药物可用于化学预防，并可能大幅降低风险。必须评估风险和益处，并且必须与患者讨论其不良事件以及关于最佳治疗的决定。携带BRCA1/2突变（极高风险）的女性可从预防性手术干预中获益，如双侧乳房切除术和/或双侧输卵管卵巢切除术。这组患者必须由多学科团队进行监测，在手术前就所提供的手术治疗、重建技术以及风险和并发症进行解释。
