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Is chemoprevention practical?

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Abstract

Breast cancer chemoprevention is practical only if 1) it reduces the incidence of cancer and overall mortality in a cost-effective manner, and 2) an easily identified target population is willing to undergo treatment. In the past decade, it was demonstrated that breast cancer risk reduction is possible with tamoxifen and raloxifene and is cost effective on the higher end of the risk continuum. However, uptake has not been optimal due to concerns of side effects, incomplete efficacy, and uncertainty regarding who is most likely to benefit. For prevention to be considered effective and practical, we need to develop 1) more accurate methods of risk assessment; 2) prevention interventions with fewer side effects and/or greater efficacy; and 3) effective means of motivating uptake of behavioral and drug prevention therapy.

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References and Recommended Reading

  1. Fisher B, Costantino JP, Wickerham DL, et al.: Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 1998, 90:1371–1388.

    Article  PubMed  CAS  Google Scholar 

  2. Veronesi U, Maisonneuve P, Costa A, et al.: Prevention of breast cancer with tamoxifen: preliminary findings from the Italian randomised trial among hysterectomised women. Lancet 1998, 352:93–97.

    PubMed  CAS  Google Scholar 

  3. Powles T, Eeles R, Ashley S, et al.: Interim analysis of the incidence of breast cancer in the Royal Marsden Hospital tamoxifen randomized chemoprevention trial. Lancet 1998, 352:98–101.

    PubMed  CAS  Google Scholar 

  4. Cuzick J, Forbes J, Edwards R, et al.: First results from the International Breast Cancer Intervention Study (IBIS-I): a randomised prevention trial. Lancet 2002, 360:817–824.

    Article  PubMed  CAS  Google Scholar 

  5. Cuzick J, Powles T, Veronesi U, et al.: Overview of the main outcomes in breast-cancer prevention trials. Lancet 2003, 361:296–300.

    Article  PubMed  CAS  Google Scholar 

  6. Port ER, Montgomery LL, Heerdt AS, et al.: Patient reluctance toward tamoxifen use for breast cancer primary prevention. Ann Surg Oncol 2001, 8:580–585.

    Article  PubMed  CAS  Google Scholar 

  7. Tchou J, Hou N, Rademaker A, et al.: Acceptance of tamoxifen chemoprevention by physicians and women at risk. Cancer 2004, 100:1800–1806.

    Article  PubMed  Google Scholar 

  8. Gail MH, Costantino JP, Bryant J, et al.: Weighing the risks and benefits of tamoxifen treatment for preventing breast cancer. J Natl Cancer Inst 1999, 91:1829–1846.

    Article  PubMed  CAS  Google Scholar 

  9. Freedman AN, Graubard BI, Rao SR, et al.: Estimates of the number of US women who could benefit from tamoxifen for breast cancer chemoprevention. J Natl Cancer Inst 2003, 95:526–532.

    PubMed  CAS  Google Scholar 

  10. Melnikow J, Kuenneth C, Helms LJ, et al.: Chemoprevention: drug pricing and mortality: the case of tamoxifen. Cancer 2006, 107:950–958.

    Article  PubMed  Google Scholar 

  11. Col NF, Goldberg RJ, Orr RK, et al.: Survival impact of tamoxifen use for breast cancer risk reduction: projections from a patient-specific Markov model. Med Decis Making 2002, 22:386–393.

    PubMed  Google Scholar 

  12. Hartmann LC, Sellers TA, Frost MH, et al.: Benign breast disease and the risk of breast cancer. N Engl J Med 2005, 353:229–237.

    Article  PubMed  CAS  Google Scholar 

  13. Allred DC, Mohsin SK, Fuqua SA: Histological and biological evolution of human premalignant breast disease. Endocrine Related Cancer 2001, 8:47–61.

    Article  PubMed  CAS  Google Scholar 

  14. Vogel VG, Costantino JP, Wickerham DL, Cronin WM: Re: tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 2002, 94:1504.

    PubMed  CAS  Google Scholar 

  15. Menon S, Porter GJ, Evans AJ, et al.: The significance of lobular neoplasia on needle core biopsy of the breast. Virchows Arch 2008, 452:473–479.

    Article  PubMed  CAS  Google Scholar 

  16. Hoogerbrugge N, Bult P, deWidt-Levert LM, et al.: High prevalence of premalignant lesions in prophylactically removed breasts from women at hereditary risk for breast cancer. J Clin Oncol 2003, 21:41–45.

    Article  PubMed  CAS  Google Scholar 

  17. Wrensch MR, Petrakis NL, Miike R, et al.: Breast cancer risk in women with abnormal cytology in nipple aspirates of breast fluid. J Natl Cancer Inst 2001, 93:1791–1798.

    Article  PubMed  CAS  Google Scholar 

  18. Fabian CJ, Kimler BF, Zalles CM, et al.: Short-term breast cancer prediction by random periareolar fine-needle aspiration cytology and the Gail risk model. J Natl Cancer Inst 2000, 92:1217–1227.

    Article  PubMed  CAS  Google Scholar 

  19. Dooley WC, Ljung BM, Veronesi U, et al.: Ductal lavage for detection of cellular atypia in women at high risk for breast cancer. J Natl Cancer Inst 2001, 93:1624–1632.

    PubMed  CAS  Google Scholar 

  20. Goldenberg VK, Seewaldt VL, Scott S, et al.: Atypia in random periareolar fine needle aspiration affects the decision of high-risk women to take tamoxifen for breast cancer chemoprevention. Cancer Epidemiol Biomarkers Prev 2007, 16:1032–1034.

    Article  PubMed  CAS  Google Scholar 

  21. Ozanne EM, Esserman LJ: Evaluation of breast cancer risk assessment techniques: a cost-effectiveness analysis. Cancer Epidemiol Biomarkers Prev 2004, 13:2043–2052.

    PubMed  CAS  Google Scholar 

  22. Bober SL, Hoke LA, Duda RB, et al.: Decision-making about tamoxifen in women at high risk for breast cancer: clinical and psychological factors. J Clin Oncol 2004, 22:4951–4957.

    Article  PubMed  Google Scholar 

  23. Goetz MP, Knox SK, Suman VJ, et al.: The impact of cytochrome P450 2D6 metabolism in women receiving adjuvant tamoxifen. Breast Cancer Res Treat 2006, 101:113–121.

    Article  PubMed  CAS  Google Scholar 

  24. Fisher B, Costantino JP, Wickerham DL, et al.: Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst 2005, 97:1652–1662

    PubMed  CAS  Google Scholar 

  25. Cuzick J, Forbes JF, Sestak I, et al.: Long-term results of tamoxifen prophylaxis for breast cancer—96-month followup of the randomized IBIS-I trial. J Natl Cancer Inst 2007, 99:272–282.

    Article  PubMed  CAS  Google Scholar 

  26. Veronesi U, Maisonneuve P, Rotmensz N, et al.: Tamoxifen for the prevention of breast cancer: late results of the Italian Randomized Tamoxifen Prevention Trial among women with hysterectomy. J Natl Cancer Inst 2007, 99:727–737.

    Article  PubMed  CAS  Google Scholar 

  27. Powles TJ, Ashley S, Tidy A, et al.: Twenty year follow-up of the Royal Marsden randomized, double-blinded tamoxifen breast cancer prevention trial. J Natl Cancer Inst 2007, 99:283–290.

    Article  PubMed  CAS  Google Scholar 

  28. Sestak I, Kealy R, Edwards R, et al.: Influence of hormone replacement therapy on tamoxifen-induced vasomotor symptoms. J Clin Oncol 2006, 24:3991–3996.

    Article  PubMed  CAS  Google Scholar 

  29. Snyder KR, Sparano N, Malinowski JM: Raloxifene hydrochloride. Am J Health Syst Pharm 2000, 57:1669–1675.

    PubMed  CAS  Google Scholar 

  30. Cummings SR, Eckert S, Krueger KA, et al.: 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, 281:2189–2197.

    Article  PubMed  CAS  Google Scholar 

  31. Martino S, Cauley JA, Barrett-Connor E, et al.: Continuing outcomes relevant to Evista: breast cancer incidence in postmenopausal osteoporotic women in a randomized trial of raloxifene. J Natl Cancer Inst 2004, 96:1751–1761.

    PubMed  CAS  Google Scholar 

  32. Vogel VG, Costantino JP, Wickerham DL, et al.: 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, 295:2727–2741.

    Article  PubMed  CAS  Google Scholar 

  33. Land SR, Wickerham DL, Costantino JP, et al.: Patientreported symptoms and quality of life during treatment with tamoxifen or raloxifene for breast cancer prevention: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA 2006, 295:2742–2751.

    Article  PubMed  CAS  Google Scholar 

  34. Grady D, Cauley JA, Geiger MJ, et al.: Reduced incidence of invasive breast cancer with raloxifene among women at increased coronary risk. J Natl Cancer Inst 2008, 100:854–861.

    Article  PubMed  CAS  Google Scholar 

  35. Allinen M, Beroukhim R, Cai L, et al.: Molecular characterization of the tumor microenvironment in breast cancer. Cancer Cell 2004, 6:17–32.

    Article  PubMed  CAS  Google Scholar 

  36. Hannemann J, Velds A, Halfwerk JB, et al.: Classification of ductal carcinoma in situ by gene expression profiling. Breast Cancer Res 2006, 8:R61.

    Article  PubMed  CAS  Google Scholar 

  37. Levy N, Tatomer D, Herber CB, et al.: Differential regulation of native estrogen receptor-regulatory elements by estradiol, tamoxifen, and raloxifene. Mol Endocrinol 2008, 22:287–303.

    Article  PubMed  CAS  Google Scholar 

  38. Meadows ES, Klein R, Rousculp MD, et al.: Cost-effectiveness of preventative therapies for postmenopausal women with osteopenia. BMC Womens Health 2007, 7:6.

    Article  PubMed  Google Scholar 

  39. Fabian CJ: Tamoxifen or raloxifene in postmenopausal women for prevention of breast cancer: a tale of two choices—counterpoint. Cancer Epidemiol Biomarkers Prev 2007, 16:2210–2212.

    Article  PubMed  CAS  Google Scholar 

  40. Jordan VC: Tamoxifen or raloxifene for breast cancer chemoprevention: a tale of two choices—point. Cancer Epidemiol Biomarkers Prev 2007, 16:2207–2209.

    Article  PubMed  CAS  Google Scholar 

  41. DrugTopics. Available at http://www.drugtopics.com. Accessed August 8, 2008.

  42. Cuzick J: Aromatase inhibitors for breast cancer prevention. J Clin Oncol 2005, 23:1636–1643.

    Article  PubMed  CAS  Google Scholar 

  43. Fabian CJ, Kimler BF, Mayo MS, Khan SA: Breast-tissue sampling for risk assessment and prevention. Endocr Relat Cancer 2005, 12:185–213.

    Article  PubMed  CAS  Google Scholar 

  44. Li Y, Zhang Y, Hill J, Kim HT, et al.: The rexinoid, bexarotene, prevents the development of premalignant lesions in MMTV-erbB2 mice. Br J Cancer 2008, 98:1380–1388.

    Article  PubMed  CAS  Google Scholar 

  45. Sporn MB: Hobson’s choice and the need for combinations of new agents for the prevention and treatment of breast cancer. J Natl Cancer Inst 2002, 94:242–243.

    PubMed  Google Scholar 

  46. Decensi A, Galli A, Veronesi U: HRT opposed to low-dose tamoxifen (HOT study): rationale and design. Recent Results Cancer Res 2003, 163:104–111.

    PubMed  CAS  Google Scholar 

  47. Fabian CJ, Kimler BF, Zalles CM, et al.: Reduction in proliferation with six months of letrozole in women on hormone replacement therapy. Breast Cancer Res Treat 2007, 106:75–84.

    Article  PubMed  CAS  Google Scholar 

  48. Chlebowski RT, Blackburn GL, Thomson CA, et al.: Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women’s Intervention Nutrition Study. J Natl Cancer Inst 2006, 98:1767–1776.

    Article  PubMed  Google Scholar 

  49. Maruti SS, Willett WC, Feskanich D, et al.: A prospective study of age-specific physical activity and premenopausal breast cancer. J Natl Cancer Inst 2008, 100:728–737.

    Article  PubMed  Google Scholar 

  50. Garland CF, Gorham ED, Mohr SB, et al.: Vitamin D and prevention of breast cancer: pooled analysis. J Steroid Biochem Mol Biol 2007, 103:708–711.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA

    Carol J. Fabian

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  1. Carol J. Fabian
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  2. Bruce F. Kimler
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Correspondence to Carol J. Fabian.

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Fabian, C.J., Kimler, B.F. Is chemoprevention practical?. Curr Breast Cancer Rep 1, 48–53 (2009). https://doi.org/10.1007/s12609-009-0007-3

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