Crew Katherine D, Albain Kathy S, Hershman Dawn L, Unger Joseph M, Lo Shelly S
Columbia University Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY USA.
Loyola University Chicago Stritch School of Medicine, Cardinal Bernardin Cancer Center, Maywood, IL USA.
NPJ Breast Cancer. 2017 May 19;3:20. doi: 10.1038/s41523-017-0021-y. eCollection 2017.
Several randomized controlled trials of anti-estrogens, such as tamoxifen and aromatase inhibitors, have demonstrated up to a 50-65% decrease in breast cancerincidence among high-risk women. Approximately 15% of women, age 35-79 years, in the U.S. meet criteria for breast cancer preventive therapies, but uptake of these medications remain low. Explanations for this low uptake includelack of awareness of breast cancer risk status, insufficient knowledge about breast cancer preventive therapies among patients and physicians, and toxicity concerns. Increasing acceptance of pharmacologic breast cancer prevention will require effective communication of breast cancer risk, accurate representation about the potential benefits and side effects of anti-estrogens, targeting-specific high-risk populations most likely to benefit from preventive therapy, and minimizing the side effects of current anti-estrogens with novel administration and dosing options. One strategy to improve the uptake of chemoprevention strategies is to consider lessons learned from the use of drugs to prevent other chronic conditions, such as cardiovascular disease. Enhancing uptake and adherence to anti-estrogens for primary prevention holds promise for significantly reducing breast cancer incidence, however, this will require a significant change in our current clinical practice and stronger advocacy and awareness at the national level.
他莫昔芬和芳香化酶抑制剂等抗雌激素药物的多项随机对照试验表明，高危女性的乳腺癌发病率降低了50%至65%。在美国，年龄在35至79岁之间的女性中，约15%符合乳腺癌预防治疗标准，但这些药物的使用率仍然很低。使用率低的原因包括对乳腺癌风险状况缺乏认识、患者和医生对乳腺癌预防治疗的了解不足以及对毒性的担忧。提高对药物性乳腺癌预防的接受度需要有效地传达乳腺癌风险，准确说明抗雌激素的潜在益处和副作用，针对最可能从预防治疗中受益的特定高危人群，并通过新颖的给药和剂量选择将当前抗雌激素的副作用降至最低。提高化学预防策略使用率的一种策略是借鉴使用药物预防其他慢性病（如心血管疾病）的经验教训。提高抗雌激素用于一级预防的使用率和依从性有望显著降低乳腺癌发病率，然而，这需要我们当前的临床实践有重大改变，并在国家层面进行更强有力的宣传和提高认识。
