Two Onc Docs Breast Cancer Screening, Prevention & Intro 2025 UPDATE
Oct 6, 2025
October marks Breast Cancer Awareness Month, making this a timely discussion. Key topics include breast cancer risk factors, when to get genetic testing, and screening recommendations for high-risk individuals. They delve into the management of LCIS and DCIS, detailing treatment options like mastectomy versus lumpectomy. Insights on chemoprevention, tamoxifen's side effects, and the challenges of rare breast histologies are also explored. Plus, learn the basics of staging and when axillary dissection is necessary.
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LCIS Is A Risk Marker, Not Cancer
- LCIS is not cancer but signals increased future breast cancer risk; management focuses on risk reduction, not oncologic treatment.
- Offer chemoprevention (tamoxifen premenopausal; tamoxifen/raloxifene/AIs postmenopausal) or surgery for select patients; pleomorphic LCIS merits surgery.
DCIS Management And Chemoprevention
- Manage DCIS with mastectomy or lumpectomy ± radiation and require a 2 mm negative margin for breast conservation.
- Offer five years of endocrine therapy for ER+ DCIS to reduce ipsilateral and contralateral recurrence but counsel no overall survival benefit.
Who Should Get Chemoprevention
- Offer chemoprevention for patients with ADH, ALH, LCIS, strong family history, or Gail five-year risk >1.7% for five years.
- Use tamoxifen for premenopausal women and raloxifene or aromatase inhibitors for postmenopausal women based on side-effect profiles.