Being a vegetarian is not a 100% guaranteed that you will not get cancer. It is a healthier lifestyle, however, there are many variables that can cause cancer and breast cancer. Add to the equation, eating meat in an earlier life, environmental factors, genetics/family history, obesity, smoking, lack of exercise and history of drinking alcohol. All these factors can cause breast caner.
Moreover, know where your fruits and vegetables come from. Many of our fruits and vegetables that we eat have been treated with pesticides, (which in turn places more estrogen in our bodies, which can cause breast cells to grow abnormally).
Be aware of what vegetables that have a high estrogen content in them. Such as sweet potatoes and “true yams” are totally different vegetables from two separate botanical families. Yams are brighter, orange color and are served more frequently in stores and restaurants, have a higher estrogen component in them. Yet women who maybe at risk for breast cancer are not aware of this factor
Furthermore, there are studies that have shown curcumin and black pepper have cancer-fighting properties to help to reduce breast cancer. Other measures that can be taken to reduce breast cancer is to lower or eliminate the consumption of alcohol. Check your Vitamin D levels, it appears that women who have a low Vitamin D level are more at risk for breast cancer.
In addition to, these factors that I have mentioned above, one must get adequate sleep, exercise, and take time for you.
Being a vegetarian is not a 100% guaranteed that you will not get cancer. It is a healthier lifestyle, however, there are many variables that can cause cancer and breast cancer. Add to the equation, eating meat in an earlier life, environmental factors, genetics/family history, obesity, smoking, lack of exercise and history of drinking alcohol. All these factors can cause breast caner.
Moreover, know where your fruits and vegetables come from. Many of our fruits and vegetables that we eat have been treated with pesticides, (which in turn places more estrogen in our bodies, which can cause breast cells to grow abnormally).
Be aware of what vegetables that have a high estrogen content in them. Such as sweet potatoes and “true yams” are totally different vegetables from two separate botanical families. Yams are brighter, orange color and are served more frequently in stores and restaurants, have a higher estrogen component in them. Yet women who maybe at risk for breast cancer are not aware of this factor
Furthermore, there are studies that have shown curcumin and black pepper have cancer-fighting properties to help to reduce breast cancer. Other measures that can be taken to reduce breast cancer is to lower or eliminate the consumption of alcohol. Check your Vitamin D levels, it appears that women who have a low Vitamin D level are more at risk for breast cancer.
In addition to, these factors that I have mentioned above, one must get adequate sleep, exercise, and take time for you.
Metformin, an oral medication that is commonly used to treat diabetes, may significantly reduce the risk of multiple types of cancer in diabetics, including cancers of the breast, prostate, pancreas, colon and rectum (although the published research in this area is overwhelmingly based upon retrospective, and hence less accurate, data). The vast majority of metformin cancer prevention studies have been performed in diabetics who are already taking metformin (http://doctorwascher.com/Archives/7-12-09.htm). As diabetes is, by itself, a significant risk factor for cancer, it is unclear at this time if metformin can significantly decrease cancer risk in non-diabetic patients. Therefore, the use of metformin for breast cancer risk reduction should be considered investigational at this time (in both diabetics and non-diabetics). Fortunately, there are multiple ongoing prospective clinical trials looking at the role of metformin as a cancer prevention agent in both diabetic and non-diabetic patients. Unfortunately, it will likely take 5 to 10 years before the data from these trials has been collected and analyzed.
Metformin, an oral medication that is commonly used to treat diabetes, may significantly reduce the risk of multiple types of cancer in diabetics, including cancers of the breast, prostate, pancreas, colon and rectum (although the published research in this area is overwhelmingly based upon retrospective, and hence less accurate, data). The vast majority of metformin cancer prevention studies have been performed in diabetics who are already taking metformin (http://doctorwascher.com/Archives/7-12-09.htm). As diabetes is, by itself, a significant risk factor for cancer, it is unclear at this time if metformin can significantly decrease cancer risk in non-diabetic patients. Therefore, the use of metformin for breast cancer risk reduction should be considered investigational at this time (in both diabetics and non-diabetics). Fortunately, there are multiple ongoing prospective clinical trials looking at the role of metformin as a cancer prevention agent in both diabetic and non-diabetic patients. Unfortunately, it will likely take 5 to 10 years before the data from these trials has been collected and analyzed.
As I discuss in detail in my evidence-based book, A Cancer Prevention Guide for the Human Race (http://www.amazon.com/Cancer-Prevention-Guide-Human-Race/dp/1608446913), the overwhelming majority of disease prevention research, including cancer prevention research, is based upon low-level types of research, including survey-based public health studies and retrospective clinical studies. While these methods of research are rather quick and inexpensive to perform, the data that they produce is highly prone to various forms of bias. That is to say, their conclusions are often not highly accurate. On the other hand, prospective, randomized, placebo-controlled clinical research trials, when performed properly, provide the highest level of research evidence available. However, because this type of research is so demanding, and so expensive to perform, very few cancer prevention studies are performed using this high-level approach. With this in mind, it’s important to acknowledge that the vast majority of research on Vitamin D (http://www.cancercenter.com/cancer-center-news/news/vitamin-D-deficiency.cfm) as a cancer prevention agent is based upon methods that produce rather weak (and often contradictory) data. However, among all of the known vitamins, it is fair to say that only Vitamin D is still a reasonable contender as a potential cancer prevention agent, and particularly for people with low levels of this vitamin in their blood. Specifically, based upon available research data, Vitamin D appears to be potentially most effective as a prevention agent for colorectal cancer, with most studies suggesting a 25 to 30 percent reduction in the risk (http://www.doctorwascher.com/vitamin-d/vitamin-d-significantly-reduces-colorectal-cancer-risk.html) of colorectal cancer in patients who take Vitamin D supplements. In terms of recommending a daily dose for Vitamin D supplementation, there is no consensus as to how much Vitamin D should be taken as a supplement, although healthy patients can usually tolerate 1,000 to 3,000 IU per day without serious side effects. However, unfortunately, I cannot make specific recommendations regarding the optimal amount of daily Vitamin D intake at this time. Moreover, Vitamin D can be toxic when taken in high doses, and can lead to kidney stones, kidney failure, calcifications in the soft tissues of the body, GI tract ulcers, and other serious health problems. Therefore, if you are considering the addition of daily Vitamin D supplements as part of a cancer prevention lifestyle (as I discuss in my book), I recommend that you first discuss this with your personal physician. I would also recommend routine testing of your Vitamin D levels, to reduce the risk of Vitamin D toxicity.
As I discuss in detail in my evidence-based book, A Cancer Prevention Guide for the Human Race (http://www.amazon.com/Cancer-Prevention-Guide-Human-Race/dp/1608446913), the overwhelming majority of disease prevention research, including cancer prevention research, is based upon low-level types of research, including survey-based public health studies and retrospective clinical studies. While these methods of research are rather quick and inexpensive to perform, the data that they produce is highly prone to various forms of bias. That is to say, their conclusions are often not highly accurate. On the other hand, prospective, randomized, placebo-controlled clinical research trials, when performed properly, provide the highest level of research evidence available. However, because this type of research is so demanding, and so expensive to perform, very few cancer prevention studies are performed using this high-level approach. With this in mind, it’s important to acknowledge that the vast majority of research on Vitamin D (http://www.cancercenter.com/cancer-center-news/news/vitamin-D-deficiency.cfm) as a cancer prevention agent is based upon methods that produce rather weak (and often contradictory) data. However, among all of the known vitamins, it is fair to say that only Vitamin D is still a reasonable contender as a potential cancer prevention agent, and particularly for people with low levels of this vitamin in their blood. Specifically, based upon available research data, Vitamin D appears to be potentially most effective as a prevention agent for colorectal cancer, with most studies suggesting a 25 to 30 percent reduction in the risk (http://www.doctorwascher.com/vitamin-d/vitamin-d-significantly-reduces-colorectal-cancer-risk.html) of colorectal cancer in patients who take Vitamin D supplements. In terms of recommending a daily dose for Vitamin D supplementation, there is no consensus as to how much Vitamin D should be taken as a supplement, although healthy patients can usually tolerate 1,000 to 3,000 IU per day without serious side effects. However, unfortunately, I cannot make specific recommendations regarding the optimal amount of daily Vitamin D intake at this time. Moreover, Vitamin D can be toxic when taken in high doses, and can lead to kidney stones, kidney failure, calcifications in the soft tissues of the body, GI tract ulcers, and other serious health problems. Therefore, if you are considering the addition of daily Vitamin D supplements as part of a cancer prevention lifestyle (as I discuss in my book), I recommend that you first discuss this with your personal physician. I would also recommend routine testing of your Vitamin D levels, to reduce the risk of Vitamin D toxicity.
Those are excellent questions, and they are the basis for my evidence-based book, A Cancer Prevention Guide for the Human Race (http://www.amazon.com/Cancer-Prevention-Guide-Human-Race/dp/1608446913), which is the only current research-based cancer prevention book written specifically for lay readers. First, let me start by noting that the overwhelming majority of disease prevention research (http://www.doctorwascher.com/tag/prevention), including cancer prevention research, is based upon rather “low-level” types of research, including survey-based public health studies and retrospective clinical studies. While these methods of research are relatively quick and inexpensive to perform, the data that they produce is highly prone to various forms of bias. That is to say, their conclusions are often not highly accurate. On the other hand, prospective, randomized, placebo-controlled clinical research trials, when performed properly, provide the highest level of research evidence available. However, because this type of research is so demanding, and so expensive to perform, very few cancer prevention studies are performed using this “high-level” research approach. With this in mind, even rather conservative estimates of cancer risk associated with lifestyle and dietary factors suggest that somewhere between 40 and 60 percent of all cancer cases are directly linked to modifiable lifestyle, dietary, and environmental factors. (Some important cancer risk factors cannot be modified at this time, including the genes that we inherit from our parents, increasing age, and gender.) What is especially important to note is that some of the very worst cancer killers are the very same cancers that are most closely linked to modifiable lifestyle and dietary factors, including lung cancer, breast cancer, pancreatic cancer, esophageal cancer, stomach (gastric) cancer, and other common major cancers. At this time, we are able to effectively cure approximately 60 to 65 percent of all cancers. However, for many of the “bad actor” cancers, the likelihood of cure, even with aggressive treatment, remains very low at this time. As I say in A Cancer Prevention Guide for the Human Race, “…an ounce of cancer prevention is worth a ton of cancer cure!”
Those are excellent questions, and they are the basis for my evidence-based book, A Cancer Prevention Guide for the Human Race (http://www.amazon.com/Cancer-Prevention-Guide-Human-Race/dp/1608446913), which is the only current research-based cancer prevention book written specifically for lay readers. First, let me start by noting that the overwhelming majority of disease prevention research (http://www.doctorwascher.com/tag/prevention), including cancer prevention research, is based upon rather “low-level” types of research, including survey-based public health studies and retrospective clinical studies. While these methods of research are relatively quick and inexpensive to perform, the data that they produce is highly prone to various forms of bias. That is to say, their conclusions are often not highly accurate. On the other hand, prospective, randomized, placebo-controlled clinical research trials, when performed properly, provide the highest level of research evidence available. However, because this type of research is so demanding, and so expensive to perform, very few cancer prevention studies are performed using this “high-level” research approach. With this in mind, even rather conservative estimates of cancer risk associated with lifestyle and dietary factors suggest that somewhere between 40 and 60 percent of all cancer cases are directly linked to modifiable lifestyle, dietary, and environmental factors. (Some important cancer risk factors cannot be modified at this time, including the genes that we inherit from our parents, increasing age, and gender.) What is especially important to note is that some of the very worst cancer killers are the very same cancers that are most closely linked to modifiable lifestyle and dietary factors, including lung cancer, breast cancer, pancreatic cancer, esophageal cancer, stomach (gastric) cancer, and other common major cancers. At this time, we are able to effectively cure approximately 60 to 65 percent of all cancers. However, for many of the “bad actor” cancers, the likelihood of cure, even with aggressive treatment, remains very low at this time. As I say in A Cancer Prevention Guide for the Human Race, “…an ounce of cancer prevention is worth a ton of cancer cure!”
In terms of lifestyle and dietary factors that have been linked to a reduced risk of cancer, there is a rather large number of potential cancer prevention cancer agents that one can consider (for a complete discussion of this rather complex topic, please see my book, A Cancer Prevention Guide for the Human Race - http://www.amazon.com/Cancer-Prevention-Guide-Human-Race/dp/1608446913). Here at Cancer Treatment Centers of America®, Nutritionists and Naturopathic Physicians are experts on how diet and supplements can affect cancer prevention and treatment. The most consistent research findings suggest that the following aspects of what I call a “cancer prevention lifestyle” are associated with the greatest decrease in cancer risk: Mediterranean diet (a diet low in meat and other animal products; rich in fresh fruits, vegetables and whole grains; and the modest use of polyunsaturated or monounsaturated cooking oils such as olive oil and canola oil) (http://www.cancercenter.com/cancer-center-news/600.cfm) ; avoidance of obesity and diabetes; avoidance of tobacco; and three to five hours of at least moderate physical activity per week. Regarding nutritional supplements and vitamins as cancer prevention agents, most of the available research data with respect to nutritional supplement and vitamin use in patients with a generally healthy diet suggests that there is likely to be very little, if any, benefit in terms of significantly reducing one’s risk of developing cancer. While the data remains contradictory, the only vitamin for which compelling research data is available to suggest a role in cancer prevention is Vitamin D (particularly with respect to colorectal cancer prevention). Vitamin E and beta-carotene, when taken as supplements, may actually have adverse health effects, while several large prospective, randomized, placebo-controlled clinical trials have shown that Vitamin C supplements do not appear to decrease cancer risk (or cardiovascular disease risk), either. In women who are at high risk of developing breast cancer, various anti-estrogen medications can be taken to significantly reduce their lifetime risk of developing this form of cancer. The diabetes drug metformin and the curry spice turmeric have also been shown to have potential anti-cancer effects, and these two agents are currently being intensively studied, as well. In summary, there probably aren’t any “magic bullet” anti-cancer agents available at this time. However, the evidence-based strategies that I describe in A Cancer Prevention Guide for the Human Race have been associated with a 40 to 80 percent reduction in cancer risk in large public health studies from the United States and Europe.
In terms of lifestyle and dietary factors that have been linked to a reduced risk of cancer, there is a rather large number of potential cancer prevention cancer agents that one can consider (for a complete discussion of this rather complex topic, please see my book, A Cancer Prevention Guide for the Human Race - http://www.amazon.com/Cancer-Prevention-Guide-Human-Race/dp/1608446913). Here at Cancer Treatment Centers of America®, Nutritionists and Naturopathic Physicians are experts on how diet and supplements can affect cancer prevention and treatment. The most consistent research findings suggest that the following aspects of what I call a “cancer prevention lifestyle” are associated with the greatest decrease in cancer risk: Mediterranean diet (a diet low in meat and other animal products; rich in fresh fruits, vegetables and whole grains; and the modest use of polyunsaturated or monounsaturated cooking oils such as olive oil and canola oil) (http://www.cancercenter.com/cancer-center-news/600.cfm) ; avoidance of obesity and diabetes; avoidance of tobacco; and three to five hours of at least moderate physical activity per week. Regarding nutritional supplements and vitamins as cancer prevention agents, most of the available research data with respect to nutritional supplement and vitamin use in patients with a generally healthy diet suggests that there is likely to be very little, if any, benefit in terms of significantly reducing one’s risk of developing cancer. While the data remains contradictory, the only vitamin for which compelling research data is available to suggest a role in cancer prevention is Vitamin D (particularly with respect to colorectal cancer prevention). Vitamin E and beta-carotene, when taken as supplements, may actually have adverse health effects, while several large prospective, randomized, placebo-controlled clinical trials have shown that Vitamin C supplements do not appear to decrease cancer risk (or cardiovascular disease risk), either. In women who are at high risk of developing breast cancer, various anti-estrogen medications can be taken to significantly reduce their lifetime risk of developing this form of cancer. The diabetes drug metformin and the curry spice turmeric have also been shown to have potential anti-cancer effects, and these two agents are currently being intensively studied, as well. In summary, there probably aren’t any “magic bullet” anti-cancer agents available at this time. However, the evidence-based strategies that I describe in A Cancer Prevention Guide for the Human Race have been associated with a 40 to 80 percent reduction in cancer risk in large public health studies from the United States and Europe.
I really try to have them focus on 1. achieving a healthy weight 2. consuming a healthy diet 3. Avoiding chemical exposure as much as possible 4. Relieving stress in their lives 5. Making sure to manage any side effects of meds (like hormone blockers) so that they continue to take them 6. Stay up to date on all other cancer screening. My favorite book about these topics is Anti Cancer a New Way of Life by David Servan-Schrieber, MD, Phd
I really try to have them focus on 1. achieving a healthy weight 2. consuming a healthy diet 3. Avoiding chemical exposure as much as possible 4. Relieving stress in their lives 5. Making sure to manage any side effects of meds (like hormone blockers) so that they continue to take them 6. Stay up to date on all other cancer screening. My favorite book about these topics is Anti Cancer a New Way of Life by David Servan-Schrieber, MD, Phd
I have already described my thinking in this regard in a recent blog that surrounded the publication of an English study that clearly and unequivocally demonstrated the protective value of non-steroidal anti-inflammatory drugs in patient at high risk for colon cancer (http://robertanagourney.wordpress.com/category/colorectal-cancer-2/). To a large degree, cancer can be viewed as a wound that will not heal. Wound healing is a paradigm of inflammation. The more we can do in our lifestyles, diets, and therapies to reduce inflammation, the better.
I have already described my thinking in this regard in a recent blog that surrounded the publication of an English study that clearly and unequivocally demonstrated the protective value of non-steroidal anti-inflammatory drugs in patient at high risk for colon cancer (http://robertanagourney.wordpress.com/category/colorectal-cancer-2/). To a large degree, cancer can be viewed as a wound that will not heal. Wound healing is a paradigm of inflammation. The more we can do in our lifestyles, diets, and therapies to reduce inflammation, the better.
Great answers...I'd like to add that you want to aim for at least 15 servings of fruit and veges (more veges than fruit) and include at least 10 different varieties. Look for a rainbow of colors as each has its own cancer fighting properties. Limit dairy, eggs, poultry and meat, and peanuts/peanut butter as they can promote cancer friendly inflammation in the body, and in the case of the former, add unwanted hormones.
Many of the suggestions for lowering risk for breast cancer are the same recommendations I would give to lower the risk for most chronic illness. I like to speak in terms of creating the optimal healing environment in the body. - Engage daily in moderate physical activity - Avoid alcohol, transfats and processed foods - Use stress reductions techniques often - Have a positive mental outlook - Detoxify your living environment, use less synthetic chemicals in your day to day life. Use products that are healthier for your body and the environment.
Absolutely! great answer...there is no one magic thing to do. Embracing spirituality and support as well as addressing the dietary deficiencies and toxic emotional patterns that are making us sick are incredibly helpful in our quest for wellness. Please visit my post: Changing the Cancer Environment
http://elynjacobs.wordpress.com/2011/12/09/changing-the-cancer-environment/
I think this is the $64,000 question! I also think that there are some well-established domains in which you can work to optimize your wellness plan. A wellness plan is not only medical; it incorporates all areas of your well-being -- physical, mental, emotional, and spiritual. When I created my wellness plan, and as I continnue to update and refine it, I apply best practices to what works for me relative to nutrition, exercise, emotional support, and faith-based rituals.
I think that working out a nutrition and food plan is the most important change one can make for a long-term recovery. While weight loss will probably be an outcome of changing the way you eat, you first must start by examining which foods will work best for your body and what amounts you need to get optimum nutrition.
Weight control and exercise are the two related factors that are truly under our control and that might have a bearing on the outcome of treatment for early stage breast cancer.
Most women choose close surveillance, seeing their breast specialist twice a year for breast examinations along with screening. In addition to that, you may be referred for chemoprevention or hormonal treatment such as tamoxifen or if post-menopausal (raloxifene, exemestane). It is not necessary to have a mastectomy for ADH alone.
Most women choose close surveillance, seeing their breast specialist twice a year for breast examinations along with screening. In addition to that, you may be referred for chemoprevention or hormonal treatment such as tamoxifen or if post-menopausal (raloxifene, exemestane). It is not necessary to have a mastectomy for ADH alone.
High risk lesions such as atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH) and LCIS (lobular carcinoma in situ) or lobular neoplasia when identified on a needle biopsy are often followed by an open excisional biopsy as there is a 10-20% incidence of an associated cancer.
Patients can be offered chemopreventive agents such as tamoxifen or raloxifene. However, most women are generally followed twice a year with physical examinations and annual mammograms.
High risk lesions such as atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH) and LCIS (lobular carcinoma in situ) or lobular neoplasia when identified on a needle biopsy are often followed by an open excisional biopsy as there is a 10-20% incidence of an associated cancer.
Patients can be offered chemopreventive agents such as tamoxifen or raloxifene. However, most women are generally followed twice a year with physical examinations and annual mammograms.
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Moreover, know where your fruits and vegetables come from. Many of our fruits and vegetables that we eat have been treated with pesticides, (which in turn places more estrogen in our bodies, which can cause breast cells to grow abnormally).
Be aware of what vegetables that have a high estrogen content in them. Such as sweet potatoes and “true yams” are totally different vegetables from two separate botanical families. Yams are brighter, orange color and are served more frequently in stores and restaurants, have a higher estrogen component in them. Yet women who maybe at risk for breast cancer are not aware of this factor
Furthermore, there are studies that have shown curcumin and black pepper have cancer-fighting properties to help to reduce breast cancer. Other measures that can be taken to reduce breast cancer is to lower or eliminate the consumption of alcohol. Check your Vitamin D levels, it appears that women who have a low Vitamin D level are more at risk for breast cancer.
In addition to, these factors that I have mentioned above, one must get adequate sleep, exercise, and take time for you. Being a vegetarian is not a 100% guaranteed that you will not get cancer. It is a healthier lifestyle, however, there are many variables that can cause cancer and breast cancer. Add to the equation, eating meat in an earlier life, environmental factors, genetics/family history, obesity, smoking, lack of exercise and history of drinking alcohol. All these factors can cause breast caner.
Moreover, know where your fruits and vegetables come from. Many of our fruits and vegetables that we eat have been treated with pesticides, (which in turn places more estrogen in our bodies, which can cause breast cells to grow abnormally).
Be aware of what vegetables that have a high estrogen content in them. Such as sweet potatoes and “true yams” are totally different vegetables from two separate botanical families. Yams are brighter, orange color and are served more frequently in stores and restaurants, have a higher estrogen component in them. Yet women who maybe at risk for breast cancer are not aware of this factor
Furthermore, there are studies that have shown curcumin and black pepper have cancer-fighting properties to help to reduce breast cancer. Other measures that can be taken to reduce breast cancer is to lower or eliminate the consumption of alcohol. Check your Vitamin D levels, it appears that women who have a low Vitamin D level are more at risk for breast cancer.
In addition to, these factors that I have mentioned above, one must get adequate sleep, exercise, and take time for you.
Many of the suggestions for lowering risk for breast cancer are the same recommendations I would give to lower the risk for most chronic illness. I like to speak in terms of creating the optimal healing environment in the body.
- Engage daily in moderate physical activity
- Avoid alcohol, transfats and processed foods
- Use stress reductions techniques often
- Have a positive mental outlook
- Detoxify your living environment, use less synthetic chemicals in your day to day life. Use products that are healthier for your body and the environment.
Please visit my post: Changing the Cancer Environment
http://elynjacobs.wordpress.com/2011/12/09/changing-the-cancer-environment/
I think this is the $64,000 question! I also think that there are some well-established domains in which you can work to optimize your wellness plan. A wellness plan is not only medical; it incorporates all areas of your well-being -- physical, mental, emotional, and spiritual. When I created my wellness plan, and as I continnue to update and refine it, I apply best practices to what works for me relative to nutrition, exercise, emotional support, and faith-based rituals.
It is not necessary to have a mastectomy for ADH alone. Most women choose close surveillance, seeing their breast specialist twice a year for breast examinations along with screening. In addition to that, you may be referred for chemoprevention or hormonal treatment such as tamoxifen or if post-menopausal (raloxifene, exemestane).
It is not necessary to have a mastectomy for ADH alone.
Patients can be offered chemopreventive agents such as tamoxifen or raloxifene. However, most women are generally followed twice a year with physical examinations and annual mammograms. High risk lesions such as atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH) and LCIS (lobular carcinoma in situ) or lobular neoplasia when identified on a needle biopsy are often followed by an open excisional biopsy as there is a 10-20% incidence of an associated cancer.
Patients can be offered chemopreventive agents such as tamoxifen or raloxifene. However, most women are generally followed twice a year with physical examinations and annual mammograms.
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