Table 1.

Clinical challenges for breast cancer prevention

1. Risk assessment models
 Adequate tools for identification of women at high risk of breast cancer are imperative for making primary prevention efficient. Indeed, comprehensive, easily accessible, risk assessment models are required in order to develop sound breast cancer preventive programs and interventional trials.
2. Definition of high risk
 There is currently no consensus on the definition of high risk, which is regarded as mandatory for all risk communication and potential prophylactic interventions. Is a lifetime breast cancer risk above 20% considered high risk? Who owns the right to define high risk: society, health care providers, or women themselves? These questions warrant a discussion in which health-care providers, politicians/officials concerned with public policy, patients, and the healthy populations are all heard.
3. Risk communication and perception
 Additional work on risk perception and the way risk information and estimates are communicated is necessary, both how women identified as having a certain breast cancer risk perceive the risk information provided, and how physicians interpret and communicate a given risk to the woman.
4. Ethical concerns
 The concepts of breast cancer prevention represents a paradigm shift given that the majority of the population, including physicians, regard breast cancer as an unpreventable disease. Several ethical concerns arise when introducing risk assessment, communication, and intervention. Potential ethical concerns deserve a thorough debate to ensure that all parties are confident in future breast cancer prevention programs, similar to the acceptance of current preventive programs for other diseases, i.e., cardiovascular diseases.
5. Prevention trials and clinical programs
 Women identified as being at increased risk for breast cancer should not be left without options for managing their risk, but be invited to programs involving multileveled prevention depending on their identified risk. Targets for possible interventions include both modifiable lifestyle risk factors and chemoprevention, and the challenge is to identify interventions that respect the balance between benefit in risk reduction and harm from potential adverse effects of medications. Notably, the optimal and adequate intervention to prevent a given breast tumor in a given woman is of utmost importance pointing toward the need for individualized prevention strategies.