Chemoprevention & risk-reducing surgery
Drugs or surgery for people at high inherited risk, before any cancer appears.
Tamoxifen/raloxifene/anastrozole halve breast cancer incidence in high-risk women (uptake is low). Aspirin reduces colorectal cancer in Lynch syndrome (CAPP2). Risk-reducing mastectomy and salpingo-oophorectomy in BRCA carriers; opportunistic salpingectomy for the general population. Prophylactic gastrectomy in CDH1 carriers.
How it works
Remove the at-risk tissue or block the hormonal/inflammatory driver of carcinogenesis.
- Large absolute risk reduction in carriers
- Side effects deter uptake; surgery is irreversible
People with Lynch syndrome should be offered daily aspirin, which roughly halves bowel cancer risk with a delayed and durable effect. Whether a lower dose (as tested in CAPP3) is as effective, and whether the finding extends to the general population, are separate questions.
For women at raised risk, a 5-year course of tamoxifen offers long-lasting protection against the commonest kind of breast cancer. Uptake is low because of side effects and fear of rare serious harms; low-dose tamoxifen (TAM-01) is now being tested to improve the balance. It has not been shown to save lives.
Latest papers
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