It may be possible to delay the step-by-step progression towards frank invasive
cancer by avoiding one or more of the well-known clinical risk factors. In addition current clinical trials in the USA and Europe are assessing whether the use of
tamoxifen,
vitamin analogues or a
low-fat diet can delay the appearance of overt disease in women known to be at high risk, but it will be several years before such trials can be evaluated. For women seeking advice on prevention, non-toxic supplements to the diet such as
beta-carotene,
vitamin A analogues or
selenium compounds, and the avoidance of alcohol and
obesity, are examples of practical advice which can do no harm yet may help to protect against
breast cancer development. In the case of the very anxious first degree relative of a
breast cancer patient, the current choice lies essentially between regular monitoring,
mastectomy with reconstruction, early termination of ovarian activity and anti-oestrogen
therapy. Currently, considerable research is being directed towards identifying oncogenes and
growth factors which are involved in the growth of
breast cancer. In the meantime, more research needs to be devoted to the effect of various
progestagens in counteracting oestrogen support of
breast cancer growth, and to
biological observations on different formulations and doses of combined oestrogen/
progestagen preparations which may reduce
breast cancer risk both in pre- and postmenopausal women.