Vogel V G
Magee-Women's Hospital, University of Pittsburgh Cancer Institute Breast Program, University of Pittsburgh, Pittsburgh, PA 15213, USA.
J Clin Oncol. 2001 Sep 15;19(18 Suppl):87S-92S.
Validated quantitative models are available that permit the accurate estimation of a woman's risk of developing invasive breast cancer during a specified period of time. Data from the National Surgical Adjuvant Breast and Bowel Project Breast Cancer Prevention Trial indicate that tamoxifen can reduce the risk of developing breast cancer by at least 49% in women who are at increased risk. All premenopausal women whose 5-year risk of developing breast cancer is 1.67% or greater derive a net benefit from taking tamoxifen for risk reduction. Women who have either lobular carcinoma-in-situ or atypical ductal or lobular hyperplasia derive an even greater net benefit. Women who carry mutations in either the BRCA1 or BRCA2 gene will also experience reduced incidence of breast cancer with tamoxifen. Although postmenopausal women derive a net benefit from tamoxifen through the reduction of both breast cancer and bone fracture event rates, the risks of both invasive endometrial cancer and thromboembolic events must be balanced in older women. Physicians should identify appropriate candidates with whom to discuss the possible benefits of tamoxifen for reducing the risk of breast cancer.
已有经过验证的定量模型，可准确估算女性在特定时间段内患浸润性乳腺癌的风险。国家外科辅助乳腺和肠道项目乳腺癌预防试验的数据表明，他莫昔芬可使患癌风险增加的女性患乳腺癌的风险至少降低49%。所有5年患乳腺癌风险为1.67%或更高的绝经前女性服用他莫昔芬降低风险可获得净收益。患有小叶原位癌或非典型导管或小叶增生的女性获得的净收益更大。携带BRCA1或BRCA2基因突变的女性服用他莫昔芬也会降低乳腺癌发病率。虽然绝经后女性通过降低乳腺癌和骨折事件发生率从他莫昔芬中获得净收益，但老年女性必须平衡浸润性子宫内膜癌和血栓栓塞事件的风险。医生应确定合适的人选，与她们讨论他莫昔芬降低乳腺癌风险的潜在益处。
