Vogel Victor G
From the Geisinger Health System, Danville, PA.
Am Soc Clin Oncol Educ Book. 2014:34-40. doi: 10.14694/EdBook_AM.2014.34.34.
Risk for breast cancer can be easily and rapidly assessed using validated, quantitative models. Multiple randomized studies show that the selective estrogen response modifiers (SERMs) tamoxifen and raloxifene can safely reduce the risk of invasive breast cancer in both pre- and postmenopausal women. Treatment resulted in a 38% reduction in breast cancer incidence, and 42 women would need to be treated to prevent one breast cancer event in the first 10 years of follow-up. Reduction was larger in the first 5 years of follow-up than in years 5 to 10, but no studies treated patients for longer than 5 years. Thromboembolic events were significantly increased with all SERMs, whereas vertebral fractures were reduced. Tamoxifen provides net benefit to all premenopausal women who are at increased risk, whereas raloxifene reduces risk nearly as much in postmenopausal women and offers increased safety. Both tamoxifen and raloxifene reduce the incidence of in situ cancers. Lasofoxifene reduced the risk of breast cancer by 79% in postmenopausal women with osteoporosis. The MAP3 trial showed a 65% reduction in the annual incidence of invasive breast cancer in postmenopausal women who were at moderately increased risk for breast cancer who took the aromatase inhibitor exemestane. The IBIS-II trial showed a 53% reduction in the risk of invasive breast cancer in postmenopausal women aged 40 to 70 who took the aromatase inhibitor anastrozole. Of the 50 million white women in the United States aged 35 to 79, 2.4 million would have a positive benefit/risk index for chemoprevention.
使用经过验证的定量模型可以轻松快速地评估乳腺癌风险。多项随机研究表明，选择性雌激素反应调节剂（SERM）他莫昔芬和雷洛昔芬可以安全地降低绝经前和绝经后女性患浸润性乳腺癌的风险。治疗使乳腺癌发病率降低了38%，在随访的前10年中，需要治疗42名女性才能预防1例乳腺癌事件。随访的前5年中降低幅度大于第5至10年，但没有研究对患者进行超过5年的治疗。所有SERM都会显著增加血栓栓塞事件的发生，而椎体骨折则减少。他莫昔芬对所有风险增加的绝经前女性有净益处，而雷洛昔芬在绝经后女性中降低风险的程度相近且安全性更高。他莫昔芬和雷洛昔芬都能降低原位癌的发病率。拉索昔芬使患有骨质疏松症的绝经后女性患乳腺癌的风险降低了79%。MAP3试验表明，服用芳香化酶抑制剂依西美坦、乳腺癌风险中度增加的绝经后女性，浸润性乳腺癌的年发病率降低了65%。IBIS-II试验表明，服用芳香化酶抑制剂阿那曲唑的40至70岁绝经后女性，浸润性乳腺癌的风险降低了53%。在美国35至79岁的5000万白人女性中，有240万女性的化学预防效益/风险指数为阳性。
