Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO, USA.
Bernard Becker Medical Library, Washington University School of Medicine, St Louis, MO, USA.
JNCI Cancer Spectr. 2021 Jan 22;5(1). doi: 10.1093/jncics/pkaa125. eCollection 2021 Feb.
Higher mammographic breast density (MBD) is associated with an increased risk of breast cancer when compared with lower MBD, especially in premenopausal women. However, little is known about the effectiveness of chemoprevention agents in reducing MBD in premenopausal women without a history of breast cancer. Findings from this review should provide insight on how to target MBD in breast cancer prevention in premenopausal women with dense breasts.
We searched 9 electronic databases for clinical trials in English, Spanish, French, or German published until January 2020. Articles evaluating the association of pharmacological agents and MBD were included. Data were extracted on methods, type and dose of intervention, outcomes, side effects, and follow up. Quality of the studies was assessed using the US Preventive Services Task Force criteria.
We identified 7 clinical trials evaluating the associations of 6 chemoprevention agents with changes in MBD in premenopausal women without history of breast cancer. The studies evaluated selective estrogen-receptor modulators (n = 1); gonadotropin-releasing hormone agonists (n = 2); isoflavones (n = 1); vitamin D (n = 1); and Boswellia, betaine, and mayo-inositol compound (n = 1). Hormonal interventions were associated with net reductions in percent density (tamoxifen [13.4%], leuprolide acetate [8.9%], and goserelin [2.7%]), whereas nonhormonal (vitamin D and isoflavone) interventions were not. However, MBD returned to preintervention baseline levels after cessation of gonadotropin-releasing hormone agonists.
A limited number of chemoprevention agents have been shown to reduce MBD in premenopausal women. Identification of new and well-tolerated chemoprevention agents targeting MBD and larger studies to confirm agents that have been studied in small trials are urgent priorities for primary breast cancer prevention in premenopausal women with dense breasts.
与低乳腺密度（MBD）相比，较高的乳腺密度（MBD）与乳腺癌风险增加相关，尤其是在绝经前妇女中。然而，对于没有乳腺癌病史的绝经前妇女，化学预防剂在降低 MBD 方面的有效性知之甚少。本综述的结果应能深入了解如何针对致密乳房的绝经前妇女的 MBD 进行乳腺癌预防。
我们在英语、西班牙语、法语或德语的 9 个电子数据库中搜索了截至 2020 年 1 月发表的临床试验。纳入评估药物与 MBD 相关性的文章。提取方法、干预类型和剂量、结果、副作用和随访的数据。使用美国预防服务工作组标准评估研究质量。
我们确定了 7 项临床试验，评估了 6 种化学预防剂在无乳腺癌病史的绝经前妇女中与 MBD 变化的相关性。这些研究评估了选择性雌激素受体调节剂（n=1）；促性腺激素释放激素激动剂（n=2）；异黄酮（n=1）；维生素 D（n=1）；以及 Boswellia、甜菜碱和肌醇复合剂（n=1）。激素干预与密度百分比的净减少相关（他莫昔芬[13.4%]、亮丙瑞林醋酸盐[8.9%]和戈舍瑞林[2.7%]），而非激素（维生素 D 和异黄酮）干预则没有。然而，在停止使用促性腺激素释放激素激动剂后，MBD 恢复到干预前的基线水平。
少数化学预防剂已被证明可降低绝经前妇女的 MBD。确定新的和耐受性良好的针对 MBD 的化学预防剂，并对已在小型试验中研究的药物进行更大规模的研究，是致密乳房的绝经前妇女进行原发性乳腺癌预防的当务之急。
