Leggat-Barr Katherine, Yee Douglas, Duralde Erin, Hodge Caroline, Borges Virginia, Baxter Molly, Valdez Jessica, Morgan Tamandra, Garber Judy, Esserman Laura
Tufts Medical School, Boston, MA, USA.
Masonic Cancer Center Minneapolis, University of Minnesota, Minneapolis, MN, USA.
Breast Cancer Res Treat. 2025 Jan;209(1):1-14. doi: 10.1007/s10549-024-07522-4. Epub 2024 Nov 12.
Despite progress, breast cancer remains the most feared disease among women. In the USA alone, the incidence is now almost 300,000 new cancers per year, a rate that has nearly doubled in the last 30 years. Most women survive, but over 40,000 women a year still die of their disease [99]. It is the most diagnosed cancer among women and the second leading cause of cancer death. Important disparities exist in breast cancer outcomes among African American women, where women die of breast cancer at higher rates, are diagnosed younger, and at a more advanced stage. We are proposing a radical shift in our thinking about breast cancer prevention with an aspiration to dramatically lower breast cancer incidence. Most breast cancers are driven by steroid hormones. Throughout the life course, women are offered an array of hormonal treatments for menstrual cycle control, family planning, in vitro fertilization, postpartum weaning, and menopausal symptom management. There are mixed data on the extent to which each of these may contribute to increased or decreased risk for breast cancer. These endocrine manipulations could represent a great opportunity to potentially reduce breast cancer incidence and improve quality of life for survivors. To date, they have not been designed to explicitly reduce breast cancer risk. A new holistic approach will require scientists, drug developers, breast oncologists, obstetricians, gynecologists, endocrinologists, radiologists, and family medicine/internists to work together toward the common goal of reducing breast cancer risk while addressing other critical issues in women's health.
尽管取得了进展，但乳腺癌仍是女性最恐惧的疾病。仅在美国，目前每年新增癌症病例就接近30万例，这一数字在过去30年里几乎翻了一番。大多数女性能够存活下来，但每年仍有超过4万名女性死于乳腺癌[99]。乳腺癌是女性中诊断率最高的癌症，也是癌症死亡的第二大主要原因。非裔美国女性的乳腺癌治疗结果存在重大差异，她们死于乳腺癌的比例更高，被诊断时更年轻，且处于更晚期。我们提议彻底转变对乳腺癌预防的看法，期望大幅降低乳腺癌发病率。大多数乳腺癌是由类固醇激素驱动的。在整个生命过程中，女性会接受一系列激素治疗，用于控制月经周期、计划生育、体外受精、产后断奶以及管理更年期症状。关于这些治疗方法对乳腺癌风险增加或降低的具体影响程度，数据不一。这些内分泌干预措施可能是降低乳腺癌发病率并改善幸存者生活质量的绝佳机会。到目前为止，这些措施并非旨在明确降低乳腺癌风险。一种新的整体方法将需要科学家、药物研发人员、乳腺肿瘤学家、产科医生、妇科医生、内分泌学家、放射科医生以及家庭医学/内科医生共同努力，朝着降低乳腺癌风险这一共同目标迈进，同时解决女性健康中的其他关键问题。
