Division of General Internal Medicine, Breast Diagnostic Clinic, Mayo Clinic, Rochester, MN.
Division of General Internal Medicine, Breast Diagnostic Clinic, Mayo Clinic, Rochester, MN.
Mayo Clin Proc. 2021 Apr;96(4):1033-1040. doi: 10.1016/j.mayocp.2021.01.028.
Breast cancer remains the most common cancer in women in the United States. For certain women at high risk for breast cancer, endocrine therapy (ET) can greatly decrease the risk. Tools such as the Breast Cancer Risk Assessment Tool (or Gail Model) and the International Breast Cancer Intervention Study risk calculator are available to help identify women at increased risk for breast cancer. Physician awareness of family history, reproductive and lifestyle factors, dense breast tissue, and history of benign proliferative breast disease are important when identifying high-risk women. The updated US Preventive Services Task Force and American Society of Clinical Oncology guidelines encourage primary care providers to identify at-risk women and offer risk-reducing medications. Among the various ETs, which include tamoxifen, raloxifene, anastrozole, and exemestane, tamoxifen is the only one available for premenopausal women aged 35 years and older. A shared decision-making process should be used to increase the usage of ET and must be individualized. This individualized approach must account for each woman's medical history and weigh the benefits and risks of ET in combination with the personal values of the patient.
乳腺癌仍然是美国女性最常见的癌症。对于某些患有乳腺癌高风险的女性，内分泌治疗（endocrine therapy，ET）可以大大降低风险。有一些工具，如乳腺癌风险评估工具（Breast Cancer Risk Assessment Tool，或 Gail Model）和国际乳腺癌干预研究风险计算器，可用于帮助识别患有乳腺癌风险增加的女性。医生在识别高风险女性时，应了解家族史、生殖和生活方式因素、乳腺组织密度以及良性增生性乳腺疾病史。更新后的美国预防服务工作组和美国临床肿瘤学会指南鼓励初级保健提供者识别高危女性，并提供降低风险的药物。在各种 ET 中，包括他莫昔芬、雷洛昔芬、阿那曲唑和依西美坦，他莫昔芬是唯一一种可用于 35 岁及以上的绝经前女性的药物。应使用共同决策过程来增加 ET 的使用，并必须个体化。这种个体化方法必须考虑到每位女性的病史，并权衡 ET 的益处和风险，同时结合患者的个人价值观。
