This book is a logical companion volume to Women at High Risk to Breast Cancer (Kluwer, 1989) edited by me previously. It distinguishes two aspects of current ap­ proaches to clinical breast cancer prevention. The first is the need to advise individ­ ual women on how they might reduce their personal risk, while the second is the design of measures aimed at reducing the total incidence of breast cancer in the community. While the former is a problem faced daily by clinicians, the latter is a goal which will involve large scale, carefully planned interventional studies. Because knowledge of the risk factors for breast cancer is incomplete and clinical trial reports are scarce, there is as yet, no scientifically-based model for personal breast cancer prevention. Nevertheless, widespread publicity associated with breast screening programmes has created a large group of highly anxious women who have been informed that they are at higher than average risk to the disease. They are con­ cerned by the personal threat posed by a family history of the disease and by the al­ leged dangers of obesity, diet, alcohol, or the use of hormonal agents such as oral contraceptives or hormone replacement therapy.

Inhalt

One: Biological Basis of Risk Factors.- 1 Defining Breast Cancer Prevention.- 2 Is Female Breast Cancer Increasing?.- 3 Hormones and Proliferative Activity in Breast Tissue.- 4 Growth Factor Expression in Breast Tissue.- 5 Avoiding Hormone-Related Risk Factors.- 6 Oral Contraceptives and Breast Disease.- 7 Hormone Replacement Therapy and Breast Cancer Risk.- 8 Diet, Alcohol, Body Size and the Prevention of Breast Cancer.- Two: Interventional Approaches.- 9 Role of Prophylactic Mastectomy.- 10 Protection by Progestagens or Antioestrogens.- 11 Chemoprevention of Breast Cancer.- 12 Methodologic Aspects of Prevention Trials.- 13 Monitoring High Risk Women: Psychological Aspects.- 14 High Risk Groups and Cost Strategies.- 15 Motivating the Public in Cancer Prevention.- 16 Approaches and Prospects.