Rastogi Priya
Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Menopause. 2008 Jul-Aug;15(4 Suppl):810-5. doi: 10.1097/gme.0b013e318178863e.
Several large, prospective trials have evaluated tamoxifen compared with placebo for breast cancer risk reduction in women at increased risk of breast cancer. Combined results from these trials demonstrate that tamoxifen at 20 mg/d reduced the incidence of breast cancer by 38%. The risk of developing breast cancer is the primary determinant of net benefit, with greater benefits accrued to women with the highest risk of breast cancer. Age and the presence of risk factors for increased toxicity also have an effect on the net benefit associated with tamoxifen. The greatest clinical benefit from tamoxifen is evident for younger women who are at lower risk of thromboembolic complications and uterine cancer, women without a uterus, and women with breast biopsy results indicative of atypical hyperplasia or lobular carcinoma in situ. Raloxifene has also been shown to reduce the risk of invasive breast cancer in women with osteoporosis and is as effective as tamoxifen for reducing the risk of invasive breast cancer in postmenopausal women at increased risk of breast cancer. In high-risk younger, postmenopausal women, raloxifene seems to offer a net benefit when comparing the reduction of risk of breast cancer and prevention of fractures with the risk of stroke, venous thromboembolic events, uterine events, and symptomatic side effects. Raloxifene offers an acceptable option for breast cancer risk reduction in postmenopausal women.
多项大型前瞻性试验评估了他莫昔芬与安慰剂相比，在乳腺癌风险增加的女性中降低乳腺癌风险的效果。这些试验的综合结果表明，每日服用20毫克他莫昔芬可使乳腺癌发病率降低38%。患乳腺癌的风险是净获益的主要决定因素，乳腺癌风险最高的女性获益更大。年龄以及毒性增加的风险因素的存在也会对与他莫昔芬相关的净获益产生影响。他莫昔芬对血栓栓塞并发症和子宫癌风险较低的年轻女性、无子宫的女性以及乳腺活检结果提示非典型增生或小叶原位癌的女性具有最大的临床益处。雷洛昔芬也已被证明可降低骨质疏松症女性患浸润性乳腺癌的风险，并且在降低乳腺癌风险增加的绝经后女性患浸润性乳腺癌的风险方面与他莫昔芬效果相当。在高危的年轻绝经后女性中，比较乳腺癌风险降低和骨折预防与中风、静脉血栓栓塞事件、子宫事件及症状性副作用的风险时，雷洛昔芬似乎能带来净获益。雷洛昔芬为绝经后女性降低乳腺癌风险提供了一个可接受的选择。
