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HPV Vaccination Recommendations
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A Study of Dietary Prudence
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Fast Facts: John Plumb Sr.
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March 10, 2008 – Elizabeth Whittington
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March 10, 2008 – Nicole LeBrasseur, PhD
Long-Distance Lifesavers
March 10, 2008 – Marc Silver
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March 10, 2008 – Curtis Pesmen
Protecting Yourself
March 10, 2008 – Katy Human
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March 10, 2008 – Erik Ness
DES Exposure: Questions and Answers
March 10, 2008 – The American Cancer Society
Are Public Awareness Campaigns Effective?
March 10, 2008 – Lacey Meyer
The New Specialty in Cancer Care
March 10, 2008 – Joanne Kenen
Below the Surface
March 10, 2008 – Nicole LeBrasseur, PhD
Another Deafening Silence
March 10, 2008 – Betty Ferrell, PhD, RN
How Out-of-Towners Stay in the Loop
March 10, 2008 – Marc Silver
Are Minorities Benefiting From Prevention Priority?
March 10, 2008 – Jo Cavallo
Marriage and Cancer?
March 10, 2008 – Curtis Pesmen
On the Defensive
March 10, 2008 – Katy Human
Breast Cancer & Lung Cancer
March 10, 2008 – Elizabeth Whittington
When the Ordinary Becomes the Ideal
March 10, 2008 – Linn Kurkjian
Straight Talk
March 10, 2008 – Erik Ness
Dieting Away Cancer?
March 10, 2008 – Lena Huang
Message from the Publisher
March 10, 2008 – Susan McClure
More Radiation in Less Time
March 10, 2008 – Laura Beil
Letters from Our Readers
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Friend in Need: Chemo Duck
March 10, 2008 – Elizabeth Whittington
www.cancer.gov/bcrisktool
March 10, 2008 – Elizabeth Whittington
Breast Cancer Risk May be Overstated in BRCA Carriers
March 10, 2008 – Elizabeth Whittington
Q&A: Predicting Breast Cancer Recurrence
March 10, 2008 – Len Lichtenfeld, MD
Journeys Through Cancer: Art of Healing & Hope
March 10, 2008 – Elizabeth Whittington
Cancer on $5 a Day (*chemo not included): How Humor Got Me Through the Toughest Journey of My Life
March 10, 2008 – Kathy LaTour
Exploring the Origin of Childhood Leukemia
March 10, 2008 – Elizabeth Whittington
We Can Weekend
March 10, 2008 – Elizabeth Whittington
Seventies Musicians Linked by Cancer
March 10, 2008 – Elizabeth Whittington
Insurance for Clinical Trial Care a State-by-State Battle
March 10, 2008 – Elizabeth Whittington

The High-Risk Crowd

Strategies for preventing cancer in people with a genetic predisposition.

BY Elizabeth Whittington
PUBLISHED March 10, 2008

When it comes to preventing cancer, everyone can benefit from exercise, not smoking, and eating a healthy diet high in fruits and vegetables. But for people with a predisposition for certain cancers, such as those with genetic mutations and a family history of cancer, prevention strategies may need to be more specific.

Chemoprevention methods, including tamoxifen, reduce the chance of breast cancer in postmenopausal women at high risk of the disease. Although tamoxifen, and now Evista (raloxifene), which was approved in September 2007 for the same indication, have been shown to prevent invasive breast cancer by up to half, women must weigh the risk of side effects, such as increased risk of endometrial cancer and stroke, with the potential cancer benefit. And while cancer incidence has been reduced, it’s not clear that mortality from the disease is lower.

Other chemoprevention methods range from aspirin for colorectal cancer to finasteride for prostate cancer, but these agents are still under investigation. The Prostate Cancer Prevention Trial, which compared finasteride with placebo in nearly 19,000 men, was stopped early in 2003 because of a clear benefit—the drug reduced the risk of prostate cancer by 25 percent. However, the study showed that among men who did develop prostate cancer, the disease was more aggressive. Finasteride is still being researched to determine the best candidates to receive the drug. Dutasteride, a second-generation drug, is also undergoing testing in prostate cancer prevention.

Prophylactic surgery, which removes tissue or an entire organ before cancer develops, can greatly lower the risk of cancer. This more drastic method is usually reserved for people with a very high risk of cancer, such as women with a family history of cancer and a BRCA mutation, which significantly increases the risk of breast and ovarian cancers. These individuals may choose to have prophylactic mastectomy and/or oophorectomy—the removal of the ovaries. Women with invasive breast cancer in one breast may choose to have both breasts removed to prevent contralateral breast cancer (when cancer develops in the second breast)—a trend that has been increasing over the past decade, according to data reported in the Journal of Clinical Oncology in late 2007.

Some people carry certain genetic mutations for colorectal cancer— hereditary nonpolyposis colorectal cancer (HNPCC) or familial adenomatous polyposis (FAP). HNPCC carries a 70 to 80 percent risk of developing the disease before age 50, with the risk of colorectal cancer reaching nearly 100 percent for people with FAP. People with these mutations often consider prophylactic removal of the colon, chemoprevention, and heightened screening.

Many individuals with a high risk of cancer choose increased screening and other non-invasive prevention methods over surgery. However, for those who undertake aggressive prevention methods, screening is still important. Tests, such as computed tomography, magnetic resonance imaging, mammography, colonoscopy, and Pap tests, among others, may need to be done frequently.

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