Breast cancer is not only increasing in the west but also particularly rapidly in eastern countries where traditionally the incidence has been low. The rise in incidence is mainly related to changes in reproductive patterns and lifestyle. These trends could potentially be reversed by defining women at greatest risk and offering appropriate preventive measures. A model for this approach was the establishment of Family History Clinics (FHCs), which have resulted in improved survival in younger women at high risk. New predictive models of risk that include reproductive and lifestyle factors, mammographic density and measurement of risk-associated single nucleotide polymorphisms (SNPs) may give more precise information concerning risk and enable better targeting for mammographic screening programmes and of preventive measures. Endocrine prevention using anti-oestrogens and aromatase inhibitors is effective, and observational studies suggest lifestyle modification may also be effective. However, referral to FHCs is opportunistic and predominantly includes younger women. A better approach for identifying older women at risk may be to use national breast screening programmes. Here were described pilot studies to assess whether the routine assessment of breast cancer risk is feasible within a population-based screening programme, whether the feedback and advice on risk-reducing interventions would be welcomed and taken up, and to consider whether the screening interval should be modified according to breast cancer risk.

中文翻译：

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在国家乳房筛查计划的背景下预防乳腺癌。

乳腺癌不仅在西方增加，而且在传统上发病率较低的东方国家也特别迅速。发病率的上升主要与生殖方式和生活方式的改变有关。通过定义风险最大的女性并提供适当的预防措施，这些趋势可能会得到扭转。这种方法的一个模型是建立家族史诊所（FHC），这提高了高危年轻女性的生存率。新的风险预测模型，包括生殖和生活方式因素、乳房 X 光检查密度和风险相关单核苷酸多态性 (SNP) 的测量，可能会提供有关风险的更精确信息，并能够更好地针对乳房 X 光检查计划和预防措施。使用抗雌激素和芳香酶抑制剂进行内分泌预防是有效的，观察性研究表明改变生活方式也可能有效。然而，转诊到 FHC 是机会主义的，主要包括年轻女性。识别有风险的老年妇女的更好方法可能是使用国家乳房筛查计划。这里描述了一些试点研究，以评估在基于人群的筛查计划中对乳腺癌风险进行常规评估是否可行，关于降低风险干预措施的反馈和建议是否会受到欢迎和采纳，并考虑筛查间隔是否应该根据乳腺癌风险进行修改。转诊到 FHC 是机会主义的，主要包括年轻女性。识别有风险的老年妇女的更好方法可能是使用国家乳房筛查计划。这里描述了一些试点研究，以评估在基于人群的筛查计划中对乳腺癌风险进行常规评估是否可行，关于降低风险干预措施的反馈和建议是否会受到欢迎和采纳，并考虑筛查间隔是否应该根据乳腺癌风险进行修改。转诊到 FHC 是机会主义的，主要包括年轻女性。识别有风险的老年妇女的更好方法可能是使用国家乳房筛查计划。这里描述了一些试点研究，以评估在基于人群的筛查计划中对乳腺癌风险进行常规评估是否可行，关于降低风险干预措施的反馈和建议是否会受到欢迎和采纳，并考虑筛查间隔是否应该根据乳腺癌风险进行修改。