Powles Trevor J
Parkside Oncology Clinic London, UK.
Adv Exp Med Biol. 2008;630:232-6. doi: 10.1007/978-0-387-78818-0_15.
The development of breast cancer is dependant in part on oestrogen. Suppression of ovarian function or use of anti-oestrogens will reduce the incidence of breast cancer. Many trials have now been done involving tens of thousands of healthy women evaluating the use of selective oestrogen receptor modulators to reduce the risk of breast cancer in healthy women. Tamoxifen will reduce the early incidence of breast cancer in pre and postmenopausal women by about 40% but causes vasomotor symptoms, thromboembolism and gynaecological toxicity including polyps, endometrial atypia and rarely cancer. In long follow up trials the risk reduction for breast cancer extends beyond the treatment period out to at least 15 years appearing to get larger with time indicating a true long term prevention effect. The toxicity of tamoxifen is for the most part confined to the treatment period. Raloxifene also has similar breast cancer risk reduction activity to tamoxifen but has less toxicity with no evidence of an increased risk of endometrial atypia or cancer. Tamoxifen is licensed for breast cancer risk reduction in the USA and raloxifene has also recently been approved by the FDA for such use.
乳腺癌的发生部分取决于雌激素。抑制卵巢功能或使用抗雌激素药物可降低乳腺癌的发病率。目前已经进行了许多试验，涉及数以万计的健康女性，评估使用选择性雌激素受体调节剂来降低健康女性患乳腺癌的风险。他莫昔芬可使绝经前和绝经后女性乳腺癌的早期发病率降低约40%，但会引起血管舒缩症状、血栓栓塞以及包括息肉、子宫内膜异型增生且极少引发癌症的妇科毒性。在长期随访试验中，乳腺癌风险降低的作用不仅限于治疗期，至少持续15年，且随着时间推移似乎作用更大，表明具有真正的长期预防效果。他莫昔芬的毒性大多局限于治疗期。雷洛昔芬也具有与他莫昔芬相似的降低乳腺癌风险的活性，但毒性较小，没有证据表明子宫内膜异型增生或癌症风险增加。在美国，他莫昔芬被批准用于降低乳腺癌风险，雷洛昔芬最近也已获得美国食品药品监督管理局的此类用途批准。
