Nayfield S G, Karp J E, Ford L G, Dorr F A, Kramer B S
Community Oncology and Rehabilitation Branch, National Cancer Institute, Bethesda, Md 20892.
J Natl Cancer Inst. 1991 Oct 16;83(20):1450-9. doi: 10.1093/jnci/83.20.1450.
Despite advances in early detection and treatment of breast cancer, primary prevention has not been well explored, especially for women at increased risk of disease due to reproductive factors and family history. There are, however, suggestions that primary prevention of breast cancer may be a realistic objective. Randomized clinical trials of adjuvant therapy for early-stage breast cancer have demonstrated a 35% decrease in contralateral breast cancers among women receiving tamoxifen compared with controls, suggesting a potential role for tamoxifen in chemoprevention of breast cancer in women at increased risk of the disease. Adjuvant therapy studies also demonstrate that tamoxifen is well tolerated by most patients and suggest additional health benefits from alterations in plasma lipid levels and stabilization of bone mineral loss in women receiving tamoxifen. Aspects of tamoxifen pharmacology, laboratory research, and clinical experience which support its investigation as a chemopreventive agent for breast cancer are summarized, and potential toxic effects are discussed.
尽管在乳腺癌的早期检测和治疗方面取得了进展，但一级预防尚未得到充分探索，特别是对于因生殖因素和家族病史而患病风险增加的女性。然而，有迹象表明乳腺癌的一级预防可能是一个现实的目标。早期乳腺癌辅助治疗的随机临床试验表明，与对照组相比，接受他莫昔芬治疗的女性对侧乳腺癌的发生率降低了35%，这表明他莫昔芬在预防乳腺癌高危女性患癌方面具有潜在作用。辅助治疗研究还表明，大多数患者对他莫昔芬耐受性良好，并表明接受他莫昔芬治疗的女性血浆脂质水平改变和骨矿物质流失稳定还具有额外的健康益处。总结了支持将他莫昔芬作为乳腺癌化学预防剂进行研究的药理学、实验室研究和临床经验等方面，并讨论了潜在的毒性作用。
