Abstract
In 1976, Sporn defined chemoprevention as the use of natural or pharmacological agents that inhibit the development of invasive breast carcinoma by blocking changes in DNA that would initiate carcinogenesis or by preventing and reversing the progression of already present precursor lesions. Proven and well-established methods block estrogenic action in the breast through the use of SERMs (Selective Estrogen Receptor Modulators) or aromatase inhibitors.
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Cuzick J, Sestak I, Forbes JF, Dowsett M, Knox J, Cawthorn S, 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;383:1041–8. A randomized, double-blind study of 3864 high-risk postmenopausal women randomized for anastrozole or placebo use for five years. After a seven-year follow-up, 50% reduction in breast cancer was observed in the experimental group. The main side effects were related to the osteoarticular system.
Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, Vogel V, Robidoux A, Dimitrov N, Atkins J, Daly M, Wieand S, Tan-Chiu E, Ford L, Wolmark N. 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(18):1371–88. 1st randomized placebo-controlled clinical trial of chemoprevention. The study evaluated 13,338 women, mainly at high risk. After five years, a 48% reduction in the incidence of breast cancer was observed, but there was no reduction in mortality. Increased endometrial carcinoma, cataract, and DVT /PET were observed.
Goss PE, Ingle JN, Alés-MartÃnez JE, et al. Exemestane for breast-cancer prevention in postmenopausal women. NCIC CTG MAP.3 Study Investigators. N Engl J Med. 2011;364(25):2381–91. A randomized, double-blind study of 4560 high-risk postmenopausal women randomized to take exemestane or placebo for five years. After a mean follow-up of 35 months, a 65% reduction in breast cancer was observed in the experimental group. The main side effects were related to the locomotor system.
King MC, Wieand S, Hale K, Lee M, Walsh T, Owens K. Tamoxifen and breast cancer incidence among women with inherited mutations in BRCA1 and BRCA2: National Surgical Adjuvant Breast and Bowel Project (NSABP-P1) Breast Cancer Prevention Trial. JAMA. 2001;286(18):2251–6. Analysis of a small group of NSABP-P1 patients who had a proven BRCA mutation. In the 19 studied women, there was a non-significant reduction in the incidence of breast cancer only in the BRCA-2 mutation group (RR: 0.38, 95% CI: 0.06–1.56). No benefit was observed in BRCA-1 patients (RR: 1.67, 95% IC: 0.32–10.7).
Nelson HD, Fu R, Griffin JC, Nygren P, Smith B, Humphrey L. Systematic review: comparative effectiveness of medications to reduce risk for primary breast cancer. Ann Int Med. 2009;151:703–15. Systematic review with chemoprevention studies: TMX (4 studies) and ADR (2 studies). Both medications reduced the risk of invasive and in situ breast cancer, but only in HR + tumors. Fractures were also reduced, but there was an increase in thromboembolic problems and endometrial carcinoma (mainly with TMX).
Vogel VG, Costantino JP, Wickerham DL, Cronin WM, Cecchini RS, Atkins JN, 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(6):OF1–11. A randomized clinical trial of 19,747 patients comparing the use of tamoxifen with raloxifene for five years. Follow-up of 81 months. Tamoxifen was more efficient in invasive cancer chemoprevention (95% IC, 1.05–1.47) and borderline for DCIS (95% IC, 0.95–1.59), but the side effects of ADR were lower, especially in the endometrium and coagulation
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BBSG – Brazilian Breast Study Group. (2019). Prevention: Chemoprevention (Primary Prevention of Breast Cancer). In: Novita, G., Frasson, A., Millen, E., Zerwes, F., Cavalcante, F. (eds) Breast Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-13636-9_23
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DOI: https://doi.org/10.1007/978-3-030-13636-9_23
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