Progress in chemoprevention of breast cancer.
Primary prevention trials have shown that tamoxifen lowers breast cancer incidence by 30-40%. Because of the endometrial risk of tamoxifen and the pro-thrombotic effects of tamoxifen and raloxifene, different strategies are being pursued to improve the risk:benefit ratio of breast cancer chemoprevention. Thus, raloxifene is being compared with tamoxifen in a phase III trial, while the minimal active dose of tamoxifen is being assessed in phase I-II trials. Also, the combination of hormone replacement therapy (HRT) and tamoxifen may reduce the risks while retaining the benefits of either agent. Anastrozole holds promise as a preventive agent based on preliminary results on contralateral breast cancer. The identification of women at increased risk for estrogen receptor (ER)-positive breast cancer due to hormonal and reproductive factors may maximize the therapeutic index of hormonal agents. Finally, new targets that interfere with ER-negative breast carcinogenesis are being sought as one-third of breast cancers will not be preventable by hormonal interventions.
Serrano
Davide
D
Division of Chemoprevention, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy.
Perego
Elisa
E
Costa
Alberto
A
Decensi
Andrea
A
D047072:Aromatase Inhibitors; D001943:Breast Neoplasms / Q000188:drug therapy*; D018890:Chemoprevention / Q000379:methods / Q000639:trends*; D005260:Female; D017313:Fenretinide / Q000627:therapeutic use; D020249:Hormone Replacement Therapy; D006801:Humans; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D011960:Receptors, Estrogen / Q000032:analysis; D013629:Tamoxifen / Q000008:administration & dosage / Q000627:therapeutic use
D047072:Aromatase Inhibitors; D011960:Receptors, Estrogen; D013629:Tamoxifen; D017313:Fenretinide; D020849:Raloxifene Hydrochloride