Endocrine chemoprevention can substantially reduce the incidence of breast cancer in women with high-risk breast lesions, including atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and lobular carcinoma in situ (LCIS). Yet, despite decades of evidence demonstrating efficacy, uptake and persistence remain strikingly limited. This review examines the disconnect between proven preventive efficacy and real-world implementation and evaluates emerging strategies for personalized prevention. Evidence from pivotal trials, including NSABP P-1, STAR, IBIS-II, and MAP.3, confirms clinically meaningful breast cancer risk reduction with tamoxifen, raloxifene, anastrozole, and exemestane, with benefits particularly relevant to women with hormonally responsive high-risk lesions. However, preventive benefit is frequently undermined by treatment-related adverse effects, inaccurate risk perception, uncertainty regarding absolute individual benefit, inconsistent clinician counseling, and systemic barriers to preventive care. Recent advances in multivariable risk prediction, polygenic risk scores, molecular biomarkers, digital health, and artificial intelligence provide opportunities to move beyond lesion-based risk categorization toward individualized benefit–risk assessment. The central challenge in breast cancer chemoprevention is no longer demonstrating that prevention works, but determining for whom, with which agent, and at what intensity prevention delivers the greatest net benefit. Integrating clinicopathological risk, genetic and molecular information, toxicity susceptibility, and patient preferences could transform chemoprevention from a broadly recommended intervention into a precision prevention strategy, closing the gap between therapeutic efficacy and population-level cancer prevention.
Breast cancer is the most common malignancy in reproductive-age women, and its incidence is rising fastest in those under 50 as early-stage survival exceeds 90
To evaluate contemporary upgrade rates of atypical ductal hyperplasia diagnosed on core biopsy and assess whether active surveillance may be appropriate for selected low-risk patients. Recent studies report overall upgrade rates ranging from approximately 10
The burden of breast cancer can be exacerbated by the presence of pre-existing disabilities, which is correlated with diminished participation in breast cancer screening, advanced-stage diagnoses, and reduced access to standard therapeutic regimens. The purpose of this review is to explore current trends in breast cancer disparities among people with disabilities, prioritizing new research conducted within the last five years. Studies report persistent disparities in preventive care and treatment faced by people with disabilities and identify specific barriers including physical access limitations, physician and patient perceptions and attitudes, and inadequate resources or support systems. Current initiatives to overcome these challenges and enhance breast cancer care in this population include the development of targeted interventions and implementation of national disability care guidelines. With ongoing advances in breast cancer care, addressing disparities experienced by people with disabilities is essential to ensure equitable and concordant care delivery.
Breast cancer education and outreach extend beyond awareness campaigns and serve as critical tools to promote early detection, improve health literacy, and reduce disparities in outcomes. Persistent inequities related to socioeconomic status, race and ethnicity, disability, geography, language, and health literacy continue to limit access to breast cancer education and outreach. The purpose of this review is to analyze recent evidence on breast cancer education and outreach strategies, highlighting successful implementation models, persistent barriers, and approaches that support long-term sustainability. Culturally tailored, community-based interventions delivered by trusted messengers consistently improve breast cancer knowledge and screening participation. However, stigma, fatalistic beliefs, and the spread of misinformation remain major barriers, especially when reinforced by cultural norms and digital media. One of the greatest concerns is the sustainability of efforts over time to address these challenges, and sustainable progress is most evident in programs integrated into existing health systems, supported by long-term policy commitments, workforce training, patient navigation, and community partnerships, rather than by short-term awareness campaigns. Emerging digital tools have expanded opportunities for education and outreach, but their implementation must be followed by government support, evidence-based tools and trusted communication strategies to ensure accuracy and mitigate misinformation. This review synthesizes successful education and outreach models across diverse countries, highlighting implementation strategies that have demonstrated effectiveness and sustainability, as well as gaps that have led to failure over time. This evidence can guide future breast cancer education and outreach initiatives, which should aim to be culturally responsive, evidence-based, and integrated into routine health systems to improve early detection and outcomes worldwide.
