Thomsen Annelise, Kolesar Jill M
School of Pharmacy, University of Wisconsin, Madison, WI 53705, USA.
Am J Health Syst Pharm. 2008 Dec 1;65(23):2221-8. doi: 10.2146/ajhp070663.
The risk factors for and risk assessment of breast cancer, recommendations for risk reduction, and roles of tamoxifen and raloxifene in the prevention of breast cancer are discussed.
Breast cancer either may be a familial syndrome or develop sporadically. In familial syndromes, cancer occurs in multiple family members and the risk factors are primarily genetic. The majority of breast cancers are sporadic, and risk factors are primarily related to estrogen exposure. Recommendation strategies for reducing breast cancer risk include engaging in a healthy lifestyle by decreasing alcohol consumption, following a low-fat diet enriched with fruits and vegetables, exercising, and reducing weight if obese. Breast self-examinations, clinical breast examinations, and screening mammographies are strategies for the early detection of breast cancer. Recommendations for the use of tamoxifen for risk reduction are intended only for women who are at an increased risk for the development of breast cancer as assessed by the Gail model. One study found a significantly increased risk of cardiovascular events and hypertriglyceridemia in the tamoxifen group compared to placebo. Raloxifene is also intended for women at high risk for breast cancer. During clinical trials, hot flashes, influenza like syndromes, peripheral edema, and leg cramps were reported more frequently in patients receiving raloxifene when compared with patients receiving placebo, and the risk of thromboembolic disease was 3.1 times higher in the raloxifene group compared with the placebo.
Tamoxifen and raloxifene are both indicated for and equally effective in the prevention of breast cancer in women at high risk for development of the disease. Raloxifene may have a more favorable adverse-effect profile, with fewer thromboembolic events and less uterine hyperplasia when compared with tamoxifen. Despite being at high risk, many women decide against breast cancer chemoprevention with either tamoxifen or raloxifene.
讨论乳腺癌的危险因素与风险评估、降低风险的建议以及他莫昔芬和雷洛昔芬在预防乳腺癌中的作用。
乳腺癌既可能是一种家族性综合征，也可能散发发生。在家族性综合征中，癌症发生在多个家庭成员中，危险因素主要是遗传性的。大多数乳腺癌是散发性的，危险因素主要与雌激素暴露有关。降低乳腺癌风险的推荐策略包括通过减少饮酒、遵循富含水果和蔬菜的低脂饮食、锻炼以及肥胖者减重来保持健康的生活方式。乳房自我检查、临床乳房检查和乳腺钼靶筛查是早期发现乳腺癌的策略。使用他莫昔芬降低风险的建议仅适用于经盖尔模型评估患乳腺癌风险增加的女性。一项研究发现，与安慰剂组相比，他莫昔芬组心血管事件和高甘油三酯血症的风险显著增加。雷洛昔芬也适用于乳腺癌高危女性。在临床试验中，与接受安慰剂的患者相比，接受雷洛昔芬的患者更频繁地报告潮热、流感样综合征、外周水肿和腿部痉挛，并且雷洛昔芬组血栓栓塞性疾病的风险比安慰剂组高3.1倍。
他莫昔芬和雷洛昔芬都适用于预防乳腺癌高危女性患乳腺癌，且效果相同。与他莫昔芬相比，雷洛昔芬可能具有更有利的不良反应谱，血栓栓塞事件更少，子宫增生也更少。尽管处于高危状态，但许多女性决定不使用他莫昔芬或雷洛昔芬进行乳腺癌化学预防。
