CLINICAL MANAGEMENT OF WOMEN AT INCREASED RISK FOR BREAST-CANCER

A large number of women in the population are at risk for the developm ent of breast cancer. Methods now exist to accurately assess risk and to provide quantitative estimates of the chance of a woman developing breast cancer in her lifetime. Histologic assessment of premalignant b reast pathology aids in the evaluation of risk. The availability of pr imary chemoprevention clinical trials reduces the number of indication s for prophylactic mastectomy. Women at risk for breast cancer and wom en who have had a malignant lesion at another anatomic site have an in creased risk for new cancers at multiple sites. We propose screening s trategies based on epidemiologic information about the risks of these diseases and on the predictive value of the available screening tests. The merits and inadequacies of specific management strategies are con sidered. We review the risks and benefits of estrogen replacement ther apy for women at increased risk for breast cancer and consider the eth ical implications of both risk assessment and the various intervention s.