Sénéchal Claire, Reyal Fabien, Callet Nasrine, This Pascale, Noguès Catherine, Stoppa-Lyonnet Dominique, Fourme Emmanuelle
Institut Curie, service de génétique, 26, rue d'Ulm, 75248 Paris cedex 5, France; Institut Bergonié, service de génétique - service de gynécologie, 229, cours de l'Argonne, 33000 Bordeaux, France.
Institut Curie, département de chirurgie, 75005 Paris, France.
Bull Cancer. 2016 Mar;103(3):273-81. doi: 10.1016/j.bulcan.2016.01.001. Epub 2016 Feb 3.
In France, women carrying BRCA1/2 mutation, at an identified high risk of breast cancer are recommended to undergo breast MRI screening. That screening does not however prevent the risk of developing a breast cancer. The only alternative to breast cancer screening available in France is surgical prevention by prophylactic mastectomy. An interesting option for women who wish to reduce their breast cancer risk, but are unready for prophylactic mastectomy is a preventive hormonal treatment by aromatase inhibitors, or selective estrogens receptor modulators (SERMs). Reliable clinical trials show the efficiency of tamoxifen, raloxifen, exemestane, and anastrozole especially, in reducing breast cancer incidence by 33%, 34%, 65% and 53% respectively. This article tries to sum up the main published trials of breast cancer prevention with hormonal treatment, and presents the latest American and English clinical guidelines concerning hormonal prevention for women at high risk of breast cancer, and starts thinking about the possibilities of hormonoprevention, especially among women carrying a BRCA1/2 mutation in France.
在法国,携带BRCA1/2突变且被确定为乳腺癌高风险的女性,建议接受乳腺磁共振成像筛查。然而,这种筛查并不能预防患乳腺癌的风险。在法国,乳腺癌筛查的唯一替代方法是通过预防性乳房切除术进行手术预防。对于那些希望降低乳腺癌风险,但尚未准备好接受预防性乳房切除术的女性来说,一个有趣的选择是使用芳香化酶抑制剂或选择性雌激素受体调节剂(SERM)进行预防性激素治疗。可靠的临床试验表明,他莫昔芬、雷洛昔芬、依西美坦和阿那曲唑尤其有效,分别可将乳腺癌发病率降低33%、34%、65%和53%。本文试图总结已发表的关于激素治疗预防乳腺癌的主要试验,并介绍美国和英国关于乳腺癌高风险女性激素预防的最新临床指南,并开始思考激素预防的可能性,尤其是在法国携带BRCA1/2突变的女性中。