Skip to main content

Advertisement

Log in

Chemoprevention of breast cancer

  • Conference Paper
  • Invited Lecture
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Trials with tamoxifen have clearly shown that the risk of developing oestrogen receptor positive breast cancer can be reduced at a late stage in the natural history with prophylactic agents. About half of the oestrogen receptor positive cases were prevented, but there was no beneficial effect on ER-negative cancers. The current challenge is to find new agents which achieve this or better efficacy but with fewer side effects. Recent results indicate that the SERM raloxifene has similar efficacy to tamoxifen, but leads to fewer endometrial cancers, gynaecologic symptoms, and thromboembolic events. Results for contralateral tumours in adjuvant trials suggest that aromatase inhibitors may be able to prevent up to 70–80% of ER-positive breast cancers, and this is currently being investigated in two large prevention trials, one using anastrozole (IBIS-II) and the other exemestane (MAP.3). New agents are needed, for receptor negative breast cancer and several possibilities are currently under investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Parkin DM, Bray F, Ferlay J, et al. Global Cancer Statistics, 2002. CA Cancer J Clin. 2005;55(2):74–108.

    Article  PubMed  Google Scholar 

  2. Bernstein L, Patel AV, Ursin G, et al. Lifetime recreational exercise activity and breast cancer risk among black women and white women. J Natl Cancer Inst. 2005;97(22):1671–9.

    PubMed  Google Scholar 

  3. Eliassen AH, Colditz GA, Rosner B, Willett WC, Hankinson SE. Adult weight change and risk of postmenopausal breast cancer. JAMA. 2006;296(2):193–201.

    Article  PubMed  CAS  Google Scholar 

  4. Wolfe JN. Risk for breast cancer development determined by mammographic parenchymal pattern. Cancer. 1976;37:2486–92.

    Article  PubMed  CAS  Google Scholar 

  5. Warner E, Lockwood G, Tritchler D, Boyd NF. The risk of breast cancer associated with mammographic parenchymal patterns: a meta-analysis of the published literature to examine the effect of method of classification. Cancer Detect Prev. 1992;16(1):67–72.

    PubMed  CAS  Google Scholar 

  6. Brisson J, Diorio C, Masse B. Wolfe’s parenchymal pattern and percentage of the breast with mammographic densities: redundant or complementary classifications? Cancer Epidemiol Biomarkers Prev. 2003;12(8):728–32.

    PubMed  Google Scholar 

  7. Boyd NF, Byng R, Jong E. Quantitative classification of mammographic densities and breast cancer risk: results from the Canadian national breast screening study. J Natl Cancer Inst. 1995;87:670–5.

    Article  PubMed  CAS  Google Scholar 

  8. Boyd NF, Guo H, Martin LJ, et al. Mammographic density and the risk and detection of breast cancer. N Engl J Med. 2007;356(3):227–36.

    Article  PubMed  CAS  Google Scholar 

  9. Cuzick J, Warwick J, Pinney E, et al. Tamoxifen and breast density in women at increased risk of breast cancer. J Natl Cancer Inst. 2004;96(8):621–8.

    PubMed  CAS  Google Scholar 

  10. Greendale GA, Reboussin BA, Slone S, et al. Postmenopausal hormone therapy and change in mammographic density. J Natl Cancer Inst. 2003;95:30–7.

    Article  PubMed  CAS  Google Scholar 

  11. Cuzick J, Baum M. Tamoxifen and contralateral breast cancer. Lancet. 1985;2(8449):282.

    Article  PubMed  CAS  Google Scholar 

  12. Jordan C. Tamoxifen for the prevention of breast cancer. In: DeVita, et al editor. Cancer Prevention 1990 p. 1–12.

  13. Cuzick J, Wang DY, Bulbrook RD. The prevention of breast cancer. Lancet. 1986;2(8472):83–6.

    Article  Google Scholar 

  14. Cuzick J, Powles T, Veronesi U, et al. Overview of the main outcomes in breast cancer prevention trials. Lancet. 2003;361(9354):296–300.

    Article  PubMed  CAS  Google Scholar 

  15. Cuzick J, Forbes JF, Sestak I, Cawthorn S, Hamed H, Holli K, Howell A. Long-term results of tamoxifen prophylaxis for breast cancer – 96-month follow-up of the randomized IBIS-I trial. J Natl Cancer Inst. 2007;99:272–82.

    Article  PubMed  CAS  Google Scholar 

  16. Powles TJ, Ashley S, Tidy A, Smith IE, Dowsett M. Twenty-year follow-up of the Royal Marsden randomized, double-blinded tamoxifen breast cancer prevention trial. J Natl Cancer Inst. 2007;99(4):283–90.

    Article  PubMed  CAS  Google Scholar 

  17. Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) investigators. JAMA. 1999;282(7):637–45.

    Article  PubMed  CAS  Google Scholar 

  18. Cummings SR, Eckert S, Krueger KA, Grady D, Powles TJ, Cauley JA, Norton L, Nickelsen T, Bjarnason NH, Morrow M, Lippman ME, Black D, Glusman JE, Costa A, Jordan VC. The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple Outcomes of Raloxifene Evaluation. JAMA. 1999;281(23):2189–97.

    Google Scholar 

  19. Martino S, Cauley JA, Barrett-Connor E, Powles TJ, Mershon J, Disch D, Secrest RJ, Cummings SR, CORE Investigators. Continuing outcomes relevant to Evista: breast cancer incidence in postmenopausal osteoporotic women in a randomized trial of raloxifene. J Natl Cancer Inst. 2004;96(23):1751-61.

    Google Scholar 

  20. Barrett-Connor E, Mosca L, Collins P, et al. Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women. N Engl J Med. 2006;355(2):125–37.

    Article  PubMed  CAS  Google Scholar 

  21. Vogel VG, Costantino JP, Wickerham DL, Cronin WM, Cecchini RS, Atkins JN, Bevers TB, Fehrenbacher L, Pajon ER Jr, Wade JL 3rd, Robidoux A, Margolese RG, James J, Lippman SM, Runowicz CD, Ganz PA, Reis SE, McCaskill-Stevens W, Ford LG, Jordan VC, Wolmark N; National Surgical Adjuvant Breast and Bowel Project (NSABP). Effects of tamoxifen vs. raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA. 2006;295(23):2727–41.

    Google Scholar 

  22. ATAC Trialists’ Group. Results of the ATAC (Arimidex, Tamoxifen Alone or in Combination) trial after completion of 5 years’ adjuvant treatment for breast cancer. Lancet. 2005;365(9453):60–2.

    Article  CAS  Google Scholar 

  23. Boccardo F, Rubagotti A, Puntoni M, et al. Switching to anastrozole versus continued tamoxifen treatment of early breast cancer: preliminary results of the Italian Tamoxifen Anastrozole Trial. J Clin Orthod. 2005;23(22):5138–47.

    CAS  Google Scholar 

  24. Coates AS, Keshaviah A, Thurlimann B, et al. Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: update of study BIG 1–98. J Clin Oncol. 2007;25(5):486–92.

    Article  PubMed  CAS  Google Scholar 

  25. Coombes RC, Kilburn LS, Snowdon CF, Paridaens R, Coleman RE, Jones SE, Jassem J, Van de Velde CJ, Delozier T, Alvarez I, Del Mastro L, Ortmann O, Diedrich K, Coates AS, Bajetta E, Holmberg SB, Dodwell D, Mickiewicz E, Andersen J, Lonning PE, Cocconi G, Forbes J, Castiglione M, Stuart N, Stewart A, Fallowfield LJ, Bertelli G, Hall E, Bogle RG, Carpentieri M, Colajori E, Subar M, Ireland E, Bliss JM; Intergroup Exemestane Study. Survival and safety of exemestane versus tamoxifen after 2–3 years’ tamoxifen treatment (Intergroup Exemestane Study): a randomised controlled trial. Lancet. 2007;369(9561):559–70.

    Google Scholar 

  26. Goss, et al. A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early-stage breast cancer. N Engl J Med. 2003;349:1793–1802.

    Article  PubMed  CAS  Google Scholar 

  27. Jakesz R, Jonat W, Gnant M, et al. Switching postmenopausal women with endocrine-responsive early breast cancer to anastrozole after 2 years’ adjuvant tamoxifen: combined results of ABCSG Trial 8 and ARNO 95 trial. Lancet. 2005;366(9484):455–62.

    Article  PubMed  CAS  Google Scholar 

  28. Jakesz R, Samonigg H, Greil R, et al. Extended adjuvant treatment with anastrozole: results from the Austrian Breast and Colorectal Cancer Study Group Trial 6a (ABCSG-6a). Proc Am Soc Clin Oncol. 2005;23:10s abstract 527.

    Google Scholar 

  29. Mamounas E, Jeong J-H, Wickerham DL, et al. Benefit from exemestane (EXE) as extended adjuvant therapy after 5 years of tamoxifen (TAM): Intent-to-treat analysis of NSABP B-33. abstract for the San Antonio breast cancer symposium, December 2006.

  30. Eastell R, Hannon RA, Cuzick J, et al. Effect of an Aromatase inhibitor on bmd and bone turnover markers: 2-year results of the Anastrozole, Tamoxifen, Alone or in Combination (ATAC) trial. J Bone Miner Res. 2006;21(8):1215–23.

    Article  PubMed  CAS  Google Scholar 

  31. The ATAC Trialists’ Group, Buzdar A, Howell A, Cuzick J, Wale C, Distler W, Hoctin-Boes G, Houghton J, Locker GY, Nabholtz JM. Comprehensive side-effect profile of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: long-term safety analysis of the ATAC trial. Lancet Oncol. 2006;7(8):633–43.

    Article  PubMed  CAS  Google Scholar 

  32. Rahme E, Ghosn J, Dasgupta K, et al. Association between frequent use of nonsteroidal anti-inflammatory drugs and breast cancer. BMC Cancer. 2005;5:159.

    Article  PubMed  CAS  Google Scholar 

  33. Swede H, Mirand AL, Menezes RJ, et al. Association of regular aspirin use and breast cancer risk. Oncology. 2005;68(1):40–7.

    Article  PubMed  CAS  Google Scholar 

  34. Harris RE, Beebe-Donk J, Alshafie GA. Reduction in the risk of human breast cancer by selective cyclooxygenase-2 (COX-2) inhibitors. BMC Cancer. 2006;6:27.

    Article  PubMed  CAS  Google Scholar 

  35. Mazhar D, Ang R, Waxman J. COX inhibitors and breast cancer. Br J Cancer. 2006;94:346–50.

    Article  PubMed  CAS  Google Scholar 

  36. Wu K, Zhang Y, Xu XC, et al. The retinoid X receptor-selective retinoid, LGD1069, prevents the development of estrogen receptor-negative mammary tumors in transgenic mice. Cancer Res. 2002;62(22):6376–80.

    PubMed  CAS  Google Scholar 

  37. Bonovas S, Filioussi K, Tsavaris N, et al. Use of statins and breast cancer: a meta-analysis of seven randomized clinical trials and nine observational studies. J Clin Oncol. 2005;23(34):8606–12.

    Article  PubMed  Google Scholar 

  38. Cauley JA, Zmuda JM, Lui LY, et al. Lipid-lowering drug use and breast cancer in older women: a prospective study. J Womens Health (Larchmt). 2003;12(8):749–56.

    Article  Google Scholar 

  39. Eliassen AH, Colditz GA, Rosner B, et al. Serum lipids, lipid-lowering drugs, and the risk of breast cancer. Arch Intern Med. 2005;165(19):2264–71.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jack Cuzick.

Additional information

This article is based on an invited lecture delivered at the 15th Annual Meeting of the Japanese Breast Cancer Society, held in Yokohama 29–30 June 2007.

About this article

Cite this article

Cuzick, J. Chemoprevention of breast cancer. Breast Cancer 15, 10–16 (2008). https://doi.org/10.1007/s12282-007-0006-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-007-0006-z

Keywords

Navigation