Fighting Breast Cancer: A Call for a New Paradigm

Breast cancer is more common than all types of cancer except skin cancer.1 Breast cancer is also the second leading cause of cancer death in women1 and is the leading cause of all death among women aged 40–59 years:2 The lifetime risk of a woman being diagnosed with breast cancer is 14.2%.3 The mortality rate for breast cancer—26 per 100,000 women—has remained essentially unchanged over the past 60 years.3 The risk of complications from tamoxifen use is a function of age, hysterectomy status, and race.8 At present, efforts to control breast cancer are focused on mammography—a procedure that has proved effective at reducing mortality from breast cancer among women aged 50 to 75 years4,5 but does not reduce the incidence of breast cancer. Mammography also does little, if anything, to reduce the risk of mortality from breast cancer in women aged under 50 years or over 75 years.4,5 To control breast cancer more effectively, we must move beyond mammography and focus on strategies that will reduce the incidence of breast cancer as well as the mortality rate from the disease. We need to add breast cancer risk assessment to our conventional triad of mammography, Clinical Breast Exam (CBE) and Breast Self Exam (SBE). Fortunately, such breast cancer risk tools are available and validated although not widely used in clinical practice.