Family-based Breast Cancer Prevention Efforts in Adolescence.

Abstract

* Abbreviation: ACS — : American Cancer Society Family history is 1 of the strongest predictors of most cancers.1 Yet primary cancer prevention efforts are often not targeted toward individuals at greatest risk. This contrasts with a growing practice of targeting secondary prevention efforts and screening guidelines to those at greatest risk. The lack of targeted primary prevention behavioral interventions likely reflects the reality that all individuals are susceptible to cancer regardless of their family history and that most, if not all, individuals can substantially benefit from reducing cancer risk factors (eg, smoking, lack of physical activity, unhealthy diets, excessive weight gain) for optimal health and to lower chronic disease burden generally. We suspect, however, that another reason why cancer prevention efforts are not targeted toward those at highest risk is because of the lack of awareness that those at highest risk can benefit from cancer prevention interventions that target modifiable factors, and that their risk is not solely from genes. Using the example of breast cancer, we highlight the limited but growing evidence that even in women at highest risk, modifiable factors still contribute to cancer risk. We then discuss the benefits of considering family-based approaches to complement existing population approaches to cancer prevention. Growing evidence suggests that many of the modifiable risk factors that increase breast cancer also do so in those with a family history of breast cancer. For example, even in women … Address correspondence to Mary Beth Terry, Columbia University Mailman School of Public Health, Department of Epidemiology, 722 West 168th St, New York, NY 10032. E-mail: mt146{at}columbia.edu