Skip to main content

Advertisement

SpringerLink
Log in

Breast cancer prevention with anti-estrogens: review of the current evidence and future directions

  • Review Article
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

There is a potential for reducing the incidence of breast cancer by modifying or changing the reversible risk factors like dietary modifications, modifications in the sedentary life habits, etc. One of such methods which has gained popularity now is chemoprevention. Many agents have been evaluated in the chemoprevention setting in females with increased risk of breast cancers. Metformin, NSAIDS, Bisphosphonates, and statins were evaluated by various investigators with variable results. One of the agents that have been proven to be beneficial in this setting is the anti-estrogens. A major disadvantage of chemoprevention is that unlike prophylactic mastectomy it can never reduce the risk to near zero although it reduces the risk significantly. Another issue is the compliance as chemoprevention with anti-estrogens will need to be continued for 5 years while surgery is a one-time procedure. Another disadvantage is the possible side effects peculiar to each drug used which may not be a significant concern in prophylactic mastectomy group. All these factors must also be kept in mind and properly explained to the patient before starting chemoprevention using anti-estrogens. Here in this review we intend to look into the large randomized controlled trials to quantify the present status of chemoprevention with anti-estrogens.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Globocan. 2012. http://globocan.iarc.fr. Accessed 11 July 2015.

  2. Porter PL. Global trends in breast cancer incidence and mortality. Salud Publica Mex. 2009;51(Suppl 2):s141–6.

    Article  PubMed  Google Scholar 

  3. Bosetti C, Bertuccio P, Malvezzi M, Levi F, Chatenoud L, Negri E, La Vecchia C. Cancer mortality in Europe, 2005–2009, and an overview of trends since 1980. Ann Oncol. 2013;24(10):2657–71.

    Article  CAS  PubMed  Google Scholar 

  4. Rebbeck TR, Mitra N, Domchek SM, Wan F, Chuai S, Friebel TM, Panossian S, Spurdle A, Chenevix-Trench G, kConFab, Singer CF, et al. Modification of ovarian cancer risk by BRCA1/2-interacting genes in a multicenter cohort of BRCA1/2 mutation carriers. Cancer Res. 2009;69(14):5801–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. 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;90:1371–88.

    Article  CAS  PubMed  Google Scholar 

  6. 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;97:1652–62.

    Article  CAS  PubMed  Google Scholar 

  7. King MC, Wieand S, Hale K, Lee M, Walsh T, Owens K et al. Tamoxifen and breast cancer incidence among women with inherited mutations in BRCA 1 and BRCA 2: National Surgical Adjuvant Breast and Bowel project(NSABP-P1) Breast Cancer Prevention Trial. JAMA. 2001;286(18):2251–6.

  8. Goss PE, Ingle JN, Alés-Martínez JE, Cheung AM, Chlebowski RT, Wactawski-Wende J, et al. Exemestane for breast-cancer prevention in postmenopausal women. N Engl J Med. 2011;364(25):2381–91.

    Article  CAS  PubMed  Google Scholar 

  9. 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;99:727–37.

    Article  CAS  PubMed  Google Scholar 

  10. Gail MH, Costantino JP, Pee D, et al. Projecting individualized absolute invasive breast cancer risk in African American women. J Natl Cancer Inst. 2007;99(23):1782–92.

    Article  PubMed  Google Scholar 

  11. Matsuno RK, Costantino JP, Ziegler RG, et al. Projecting individualized absolute invasive breast cancer risk in Asian and Pacific Islander American women. J Natl Cancer Inst. 2011;103(12):951–61.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Tyrer J, Duffy SW, Cuzick J. A breast cancer prediction model incorporating familial and personal risk factors. Stat Med. 2004;23(7):1111–30.

    Article  PubMed  Google Scholar 

  13. Cuzick J, Forbes JF, Sestak I, et al. 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  CAS  PubMed  Google Scholar 

  14. Vogel VG, Costantino JP, Wickerham DL, et al. Update of the National Surgical Adjuvant Breast and Bowel Project Study of Tamoxifen and Raloxifene (STAR) P-2 Trial: preventing breast cancer. Cancer Prev Res (Phila). 2010;3:696–706.

    Article  CAS  Google Scholar 

  15. 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;355:125–37.

    Article  CAS  PubMed  Google Scholar 

  16. Cuzick J. Aromatase inhibitors for breast cancer prevention. J Clin Oncol. 2005;23:1636–43.

    Article  CAS  PubMed  Google Scholar 

  17. 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;99:283–90.

    Article  CAS  PubMed  Google Scholar 

  18. DeCensi A, Bonanni B, Maisonneuve P, et al. A phase-III prevention trial of low-dose tamoxifen in postmenopausal hormone replacement therapy users: the HOT study. Ann Oncol. 2013;24:2753–60.

    Article  CAS  PubMed  Google Scholar 

  19. 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;281:2189–97.

    Article  CAS  PubMed  Google Scholar 

  20. Cauley JA, Norton L, Lippman ME, et al. Continued breast cancer risk reduction in postmenopausal women treated with raloxifene: 4-year results from the MORE trial. Multiple outcomes of raloxifene evaluation. Breast Cancer Res Treat. 2001;65:125–34.

    Article  CAS  PubMed  Google Scholar 

  21. 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;96:1751–61.

    Article  CAS  PubMed  Google Scholar 

  22. Cummings SR, Ensrud K, Delmas PD, et al. Lasofoxifene in postmenopausal women with osteoporosis. N Engl J Med. 2010;362:686–96.

    Article  CAS  PubMed  Google Scholar 

  23. LaCroix AZ, Powles T, Osborne CK, et al. Breast cancer incidence in the randomized PEARL trial of lasofoxifene in postmenopausal osteoporotic women. J Natl Cancer Inst. 2010;102:1706–15.

    Article  CAS  PubMed  Google Scholar 

  24. Cummings SR, McClung M, Reginster JY, et al. Arzoxifene for prevention of fractures and invasive breast cancer in postmenopausal women. J Bone Miner Res. 2011;26:397–404.

    Article  CAS  PubMed  Google Scholar 

  25. Powles TJ, Diem SJ, Fabian CJ, et al. Breast cancer incidence in postmenopausal women with osteoporosis or low bone mass using arzoxifene. Breast Cancer Res Treat. 2012;134:299–306.

    Article  CAS  PubMed  Google Scholar 

  26. Nelson HD, Smith ME, Griffin JC, Fu R. Use of medications to reduce risk for primary breast cancer: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2013;158(8):604–14.

    Article  PubMed  Google Scholar 

  27. Veronesi U, Mariani L, Decensi A, et al. Fifteen-year results of a randomized phase III trial of fenretinide to prevent second breast cancer. Ann Oncol. 2006;17:1065–71.

    Article  CAS  PubMed  Google Scholar 

  28. Rennert G, Pinchev M, Rennert HS. Use of bisphosphonates and risk of postmenopausal breast cancer. J Clin Oncol. 2010;28:3577–81.

    Article  CAS  PubMed  Google Scholar 

  29. Chlebowski RT, Chen Z, Cauley JA, et al. Oral bisphosphonate use and breast cancer incidence in postmenopausal women. J Clin Oncol. 2010;28:3582–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Bodmer M, Meier C, Krahenbuhl S, Jick SS, Meier CR. Long-term metformin use is associated with decreased risk of breast cancer. Diabetes Care. 2010;33:1304–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Bosco JL, Antonsen S, Sorensen HT, Pedersen L, Lash TL. Metformin and incident breast cancer among diabetic women: a population-based case-control study in Denmark. Cancer Epidemiol Biomarkers Prev. 2011;20:101–11.

    Article  CAS  PubMed  Google Scholar 

  32. Cummings SR, Ettinger B, Delmas PD, et al. The effects of tibolone in older postmenopausal women. N Engl J Med. 2008;359:697–708.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Browning DR, Martin RM. Statins and risk of cancer: a systematic review and metaanalysis. Int J Cancer. 2007;120:833–43.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  35. Zhao YS, Zhu S, Li XW, et al. Association between NSAIDs use and breast cancer risk: a systematic review and meta-analysis. Breast Cancer Res Treat. 2009;117:141–50.

    Article  CAS  PubMed  Google Scholar 

  36. Rouanet P, Linares-Cruz G, Dravet F, et al. Neoadjuvant percutaneous 4-hydroxytamoxifen decreases breast tumoral cell proliferation: a prospective controlled randomized study comparing three doses of 4-hydroxytamoxifen gel to oral tamoxifen. J Clin Oncol. 2005;23:2980–7.

    Article  CAS  PubMed  Google Scholar 

  37. Waters EA, Cronin KA, Graubard BI, et al. Prevalence of tamoxifen use for breast cancer chemoprevention among US women. Cancer epidemiology, biomarkers and prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive. Oncology. 2010;19:443–6.

    CAS  Google Scholar 

  38. Ropka ME, Keim J, Philbrick JT. Patient decisions about breast cancer chemoprevention: a systematic review and meta-analysis. J Clin Oncol. 2010;28:3090–5.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India

    Supriya Mallick, Rony Benson & P. K. Julka

Authors
  1. Supriya Mallick
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rony Benson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. K. Julka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Supriya Mallick.

Ethics declarations

Financial support

No financial support received.

Conflict of interest

The authors have no conflict of interest.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Mallick, S., Benson, R. & Julka, P.K. Breast cancer prevention with anti-estrogens: review of the current evidence and future directions. Breast Cancer 23, 170–177 (2016). https://doi.org/10.1007/s12282-015-0647-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-015-0647-2

Keywords

Search

Navigation