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Background It is uncertain whether evidence supports routinely estimating a postmenopausal woman's risk of breast cancer and intervening to reduce risk. Methods We systematically reviewed prospective studies about models and sex hormone levels to assess breast cancer risk and used meta-analysis with random effects models to summarize the predictive accuracy of breast density. We also reviewed prospective studies of the effects of exercise, weight management, healthy diet, moderate alcohol consumption, and fruit and vegetable intake on breast cancer risk, and used random effects models for a meta-analyses of tamoxifen and raloxifene for primary prevention of breast cancer. All studies reviewed were published before June 2008, and all statistical tests were twosided. Results Risk models that are based on demographic characteristics and medical history had modest discriminatory accuracy for estimating breast cancer risk (c-statistics range = 0.58-0.63). Breast density was strongly associated with breast cancer (relative risk [RR] = 4.03, 95% confidence interval [Cl] = 3.10 to 5.26, for Breast Imaging Reporting and Data System category IV vs category I; RR = 4.20, 95% Cl = 3.61 to 4.89, for >75% vs Tamoxifen and raloxifene reduced the risk of estrogen receptor--positive invasive breast cancer and invasive breast cancer overall. Conclusions Evidence from this study supports screening for breast cancer risk in all postmenopausal women by use of risk factors and breast density and considering chemoprevention for those found to be at high risk. Several lifestyle changes with the potential to prevent breast cancer should be recommended regardless of risk.

Table of Contents Abstract Introduction Case Discussion References Abstract Vaginal evisceration after a motor vehicle crash caused by a pessary has not been reported. This case was missed at the [...]

Table of Contents Abstract Introduction Methods Results Discussion References Abstract Osteoporosis is a chronic and progressive disorder characterized by reduced bone strength and increased susceptibility to fracture by minor trauma. [...]