The Who, What, Where, When and Sometimes, Why.

Emerging Areas in Risk Reduction and Estimating Risk

Read our blog, “It Looks Promising”: Dr. Kornelia Polyak is Uncovering New Possibilities in Breast Cancer Prevention.

Breast cancer risk reduction and risk assessment are active areas of research.

Some studies are looking at ways to reduce risk (such as new risk-lowering drugs) in people at higher than average risk of breast cancer.

Other studies are focused on new and better ways of knowing which women and men are at higher risk.

Risk-lowering drugs

Some drugs used to treat breast cancer are under study in the risk reduction setting for women at higher risk.

New risk-lowering drugs are also being developed.

Learn about tamoxifen and raloxifene (FDA-approved drugs for lowering the risk of breast cancer).

Aromatase inhibitors

Aromatase inhibitors are hormone therapy drugs used to treat estrogen receptor-positive breast cancer in postmenopausal women.

Exemestane (Aromasin) and anastrozole (Arimidex)

Exemestane and anastrozole are aromatase inhibitor drugs. Findings from randomized controlled trials of postmenopausal women at high risk have shown exemestane and anastrozole may reduce the risk of breast cancer by about half [228-229].

Unlike tamoxifen and raloxifene (currently FDA-approved for risk reduction), exemestane and anastrozole don’t appear to increase the risk of blood clots [228-229]. However, they can cause menopausal symptoms, a loss of bone density and other side effects [228-229,373-376].

The American Society for Clinical Oncology (ASCO), the National Comprehensive Cancer Network (NCCN) and the U.S. Preventive Services Task Force list exemestane and anastrozole as risk-lowering drug options for postmenopausal women who do not have breast cancer, but are at higher risk of breast cancer.

However, exemestane and anastrozole aren’t FDA-approved for use in the risk reduction setting. They are only FDA-approved for use in breast cancer treatment.

Learn about aromatase inhibitors (including exemestane and anastrozole) and breast cancer treatment.

Learn more about the side effects of aromatase inhibitors.

Other aromatase inhibitors

The aromatase inhibitor drug letrozole (Femara) is under study to see whether it lowers breast cancer risk in postmenopausal women at high risk.

Learn about aromatase inhibitors and breast cancer treatment.


Lasofoxifene is an osteoporosis drug similar to tamoxifen and raloxifene.

Early findings suggest lasofoxifene may reduce the risk of estrogen receptor-positive breast cancer in women at increased risk of osteoporosis [380-382]. More data are needed to confirm these findings.

Clinical trials of risk-lowering drugs

If you’re at higher risk of breast cancer and considering joining a risk-lowering drug clinical trial, discuss the potential risks and benefits with your health care provider.

Susan G. Komen® Patient Care Center

If you or a loved one needs information or resources about clinical trials, the Patient Care Center can help. Contact the Komen Breast Care Helpline at 1-877-465-6636 or email

Se habla español. in collaboration with Komen offers a custom matching service to help find breast cancer risk reduction clinical trials.

Learn more about clinical trials.

Using breast cells to assess risk

Methods to assess breast cancer risk currently under study include [383]:

These procedures remove cells from the breast.

A pathologist looks at the cells under a microscope. Abnormal (atypical) cells may be linked to an increased risk of breast cancer, but these tests have not been shown to be effective for breast cancer risk assessment [383].

The procedures differ in how cells are removed from the breast. 

Ductal lavage

Ductal lavage uses a small tube to flush out fluid from the nipple. This fluid contains breast cells.

This procedure causes some discomfort.

Ductal lavage hasn’t been shown to be effective for breast cancer risk assessment [383]. So, it’s not recommended for use outside of a clinical trial.

More research is needed to learn how to use the findings from ductal lavage. 

Nipple aspiration (nipple aspirate fluid cytology)

Nipple aspiration (such as the HALO test) uses a breast pump, and sometimes massage, to remove fluid from the nipple.

Nipple aspiration hasn’t been shown to be effective for breast cancer risk assessment [383]. So, it’s not recommended for use outside of a clinical trial.

More research is needed to learn how to use the findings from nipple aspiration.

Random periareolar fine needle aspiration (RPFNA)

RPFNA uses a thin needle to remove cells from about 10 areas near the areola.

This procedure is more invasive and causes more discomfort than ductal lavage or nipple aspiration.

RPFNA is under study and is not recommended for use outside of a clinical trial.

Ductal lavage, nipple aspiration or RPFNA and risk assessment

Ductal lavage, nipple aspiration and RPFNA are not recommended for use outside of a clinical trial.

The findings from these tests should not impact a woman’s decision to take a risk-lowering drug, have preventive surgery or join a clinical trial for risk reduction. They also should not be used to assess risk for breast cancer screening recommendations.

More research is needed to learn how to use the findings from these tests.

Breast cancer risk assessment is not breast cancer screening

Tests such as ductal lavage, nipple aspiration and RPFNA are under study for risk assessment. Risk assessment is not breast cancer screening (tests used to find cancer early).

The U.S. Food and Drug Administration (FDA) says tests such as nipple aspiration are not substitutes for mammograms and should not be used in breast cancer screening or diagnosis [384].


Our commitment to research

At Susan G. Komen®, we are committed to saving lives by meeting the most critical needs in our communities and investing in breakthrough research to prevent and cure breast cancer. Our Research Program is an essential driving force for achieving this mission.

Since our inception in 1982, Komen has provided funding to support research grants that have greatly expanded our knowledge of breast cancer and helped us understand that breast cancer is not just a single disease but many diseases, unique to each individual.

To date, Komen has provided nearly $1.1 billion to researchers in 47 states, the District of Columbia and 24 countries to support research that has resulted in a better understanding of breast cancer; earlier detection; personalized, less invasive treatments for what was once a “one-treatment-fits-all” disease; and improvements in both quality of life and survival rates.

Learn more about our continuing investment in research and the exciting research that we are funding, because nothing would make us happier than ending breast cancer forever.

 Updated 04/24/24



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