From the Division of Endocrinology, University of Virginia Health System, Charlottesville, VA.
Endocrinology/Metabolism, University of California, San Diego, La Jolla, CA.
Cancer J. 2022;28(3):224-240. doi: 10.1097/PPO.0000000000000596.
Current concepts regarding estrogen and its mechanistic effects on breast cancer in women are evolving. This article reviews studies that address estrogen-mediated breast cancer development, the prevalence of occult tumors at autopsy, and the natural history of breast cancer as predicted by a newly developed tumor kinetic model.
This article reviews previously published studies from the authors and articles pertinent to the data presented.
We discuss the concepts of adaptive hypersensitivity that develops in response to long-term deprivation of estrogen and results in both increased cell proliferation and apoptosis. The effects of menopausal hormonal therapy on breast cancer in postmenopausal women are interpreted based on the tumor kinetic model. Studies of the administration of a tissue selective estrogen complex in vitro, in vivo, and in patients are described. We review the various clinical studies of breast cancer prevention with selective estrogen receptor modulators and aromatase inhibitors. Finally, the effects of the underlying risk of breast cancer on the effects of menopausal hormone therapy are outlined.
The overall intent of this review is to present data supporting recent concepts, discuss pertinent literature, and critically examine areas of controversy.
目前关于雌激素及其对女性乳腺癌的作用机制的概念正在不断发展。本文综述了研究雌激素介导的乳腺癌发生、尸检中隐匿性肿瘤的发生率以及新开发的肿瘤动力学模型预测的乳腺癌自然史的研究。
本文综述了作者先前发表的研究以及与所呈现数据相关的文章。
我们讨论了适应性超敏反应的概念，该反应是对长期缺乏雌激素的反应，导致细胞增殖和凋亡增加。基于肿瘤动力学模型，解释了绝经后女性激素治疗对乳腺癌的影响。描述了体外、体内和患者中组织选择性雌激素复合物的给药研究。我们综述了选择性雌激素受体调节剂和芳香化酶抑制剂在乳腺癌预防方面的各种临床研究。最后，概述了乳腺癌的潜在风险对绝经激素治疗效果的影响。
本文综述的总体目的是提供支持最新概念的数据，讨论相关文献，并批判性地检查有争议的领域。
