Breast Cancer Prevention Starts in Childhood

Linda Brookes, MSc; Graham A. Colditz, MD, DrPH


December 08, 2014

Primary Care for Primary Prevention

Medscape: Do we need a guideline on early prevention of breast cancer in children and adolescents that family practitioners and pediatricians can use as a reference when speaking to patients and their families?

Dr Colditz: If we don't have something that specifically addresses age, we end up not talking about prevention until people are in their 30s, 40s, and 50s. That is when, in a primary care visit, people ask what they should do about their weight or blood pressure, or changing their diet to lower their cholesterol. The point is that for breast cancer, that's starting late, given that the disease process and risk accumulation start early in life. With breast cells dividing with each menstrual cycle, there is risk accumulation. Alcohol in adolescents and before first pregnancy increases the DNA damage.

Yes, developing guidelines that are much more specific to the earlier ages feels like one step we are going to have to take to address prevention in the primary care visits of adolescents and young adults.

Medscape: Which organizations should be taking this on?

Dr Colditz: The US Preventive Services Task Force and the website Healthy People 2020, managed by the US Department of Health and Human Services—these are the avenues for getting recommendations on the radar. The American Academy of Pediatrics has taken on obesity, TV watching, and other messages as part of pediatrics care. We're not saying that just having your primary care provider talk to you about it is enough, but we know that a message from a provider is powerful reinforcement. We have to work at this initiative across multiple dimensions, but primary care providers are definitely one of the necessary components of a successful strategy.

Medscape: Is this included in any current guidelines?

Dr Colditz: Not yet. Not directly about early life and breast cancer prevention.

Medscape: Are there any relevant guidelines in development?

Dr Colditz: We're working on it. We've got to make providers aware that the evidence is strong enough to act on.


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