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Update on Breast Cancer Risk Reduction Therapy

  • Risk and Prevention (TB Bevers, Section Editor)
  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

In women at increased risk of breast cancer age ≥35 years, the selective estrogen receptor modulator (SERM) tamoxifen should be discussed as an option to reduce the risk of estrogen receptor (ER)-positive breast cancer. In postmenopausal women, raloxifene, anastrozole, and exemestane should also be discussed as options for breast cancer risk reduction. Risk reduction with SERMs continues for at least 10 years in both premenopausal and postmenopausal women. Tamoxifen is not recommended for women with a history of deep vein thrombosis, pulmonary embolus, stroke, transient ischemic attack, or during prolonged immobilization. Chemoprevention with a SERM may be particularly beneficial to women with atypical hyperplasia, a 5-year risk of more than 5 %, in women with increased mammographic density, or in women with lobular carcinoma in situ. Aromatase inhibitor therapy is of value in high-risk postmenopausal women. Toxicity with tamoxifen is minimal in premenopausal women and is less with either raloxifene or an aromatase inhibitor in postmenopausal women.

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References

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  1. 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;91:1829–46.

    Article  CAS  PubMed  Google Scholar 

  2. Tice JA, Miglioretti DL, Li C-S, et al. Breast density and benign breast disease: risk assessment to identify women at high risk of breast cancer. J Clin Oncol. 2015;33:3137–43. Mammographic density in more than 50% of breast tissue is an independent risk factor for breast cancer and may identify women who are candidates for risk reduction with SERMs.

  3. 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 

  4. Powles TJ. 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 

  5. 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 

  6. 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 

  7. 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 

  8. Cuzick J, Sestak, Cawthorn S, et al. Tamoxifen for prevention of breast cancer: extended long-term follow-up of the IBIS-I breast cancer prevention trial. Lancet Oncol. 2015;6:67–75. When follow-up was extended to 16 years, there was an enduring 30 % reduction in the risk of both ER-positive invasive breast cancer and DCIS even though active treatment with tamoxifen was stopped after 5 years. The magnitude of the benefit was as large in years 10 and later as it was in years 1–10.

  9. Cuzick J, Sestak I, Bonanni B, et al. SERM Chemoprevention of Breast Cancer Overview Group. Selective oestrogen receptor modulators in prevention of breast cancer: an updated meta-analysis of individual participant data. Lancet. 2013;381:1827–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Hartmann LC, Degnim AC, Santen RJ, et al. Atypical hyperplasia of the breast—risk assessment and management options. N Engl J Med. 2015;372:78–89. Atypical lobular or ductal hyperplasia is a very high risk lesion with the risk of developing invasive breast cancer approaching 30 % at 25 years. The risk is nearly as large as that associated with predispopsing germline genetic mutations.

  11. 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;295:2727–41.

    Article  CAS  PubMed  Google Scholar 

  12. 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. 2010;3:696–706.

    Article  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  14. Cuzick J, Sestak I, Forbes JF, et al. Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial. Lancet. 2014;383:1041–48.

    Article  CAS  PubMed  Google Scholar 

  15. Goss PE, Ingle JN, Ales-Martinez JE, et al. Exemestane for breast-cancer prevention in postmenopausal women. N Engl J Med. 2011;364:2381–91.

    Article  CAS  PubMed  Google Scholar 

  16. National Comprehensive Cancer Network (NCCN). https://www.nccn.org/professionals/physician_gls/pdf/breast_risk.pdf

  17. Visvanathan K, Hurley P, Bantug E, et al. Use of pharmacologic interventions for breast cancer risk reduction: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 2013;31:2942–62. Evidence-based recommendations for the use of pharmacological agents to reduce the risk of invasive breast cancer in high-risk women with a thorough review of the randomized, clinical trials that support their use.

  18. Nelson HD, Smith B, 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;158:604–14. Rigorous evidence-based recommendations for the use of SERMs and aromatase inhibitors to reduce the risk of breast cancer in high-risk women.

  19. Cuzick J, DeCensi A, Arun B, et al. Preventive therapy for breast cancer: an international consensus statement. Lancet Oncol. 2011;12:496–503.

    Article  CAS  PubMed  Google Scholar 

  20. Freedman AN, Costantino JP, Gail MH, et al. A benefit/risk assessment tool for breast cancer chemoprevention treatment. J Clin Oncol. 2011;29:2327–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Geisinger Health System, 100 North Academy Avenue, M. C. 20-01, Danville, PA, 17822, USA

    Victor G. Vogel

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  1. Victor G. Vogel
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Correspondence to Victor G. Vogel.

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Conflict of Interest

Victor G. Vogel reports grants from the National Cancer Institute and personal fees from Eli Lilly and Astra Zeneca.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Risk, Prevention, and Screening

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Vogel, V.G. Update on Breast Cancer Risk Reduction Therapy. Curr Breast Cancer Rep 8, 175–182 (2016). https://doi.org/10.1007/s12609-016-0221-8

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  • DOI: https://doi.org/10.1007/s12609-016-0221-8

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