Singletary S Eva
Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 444, Houston, TX 77030-4095, USA.
Ann Surg. 2003 Apr;237(4):474-82. doi: 10.1097/01.SLA.0000059969.64262.87.
To update and summarize evidence of risk factors for breast cancer.
Women who are at high risk for breast cancer have a variety of options available to them, including watchful waiting, prophylactic surgery, and chemoprevention. It is increasingly important to accurately assess a patient's risk profile to ensure that the cost/benefit ratio of the selected treatment is favorable.
Estimates of relative risk for documented risk factors were obtained from seminal papers identified in previous reviews. These estimates were updated where appropriate with data from more recent reports using large sample sizes or presenting meta-analyses of previous studies. These reports were identified from a review of the Medline database from 1992 to 2002.
Risk factors that have received a great deal of publicity (hormone use, alcohol consumption, obesity, nulliparity) present a relatively modest relative risk for breast cancer (<2). Factors associated with a prior history of neoplastic disease or atypical hyperplasia and factors associated with a genetic predisposition significantly affect the risk of breast cancer, with relative risks ranging from 3 (for some cases of positive family history) to 200 (for premenopausal women positive for a BRCA mutation).
More precise tools, based on techniques of molecular biology such as microarray analysis, will be needed to assess individual risk for breast cancer.
更新并总结乳腺癌危险因素的证据。
乳腺癌高危女性有多种选择，包括密切观察、预防性手术和化学预防。准确评估患者的风险状况以确保所选治疗的成本效益比良好变得越来越重要。
从先前综述中确定的重要论文中获取已记录危险因素的相对风险估计值。必要时，使用大样本量的最新报告数据或对先前研究进行的荟萃分析数据对这些估计值进行更新。这些报告是通过对1992年至2002年的Medline数据库进行检索确定的。
备受关注的危险因素（激素使用、饮酒、肥胖、未生育）对乳腺癌的相对风险相对较小（<2）。与肿瘤疾病或非典型增生既往史相关的因素以及与遗传易感性相关的因素会显著影响乳腺癌风险，相对风险范围从3（某些阳性家族史情况）到200（BRCA突变阳性的绝经前女性）。
需要基于微阵列分析等分子生物学技术的更精确工具来评估个体患乳腺癌的风险。
