Mansour Razan, Abunasser Mahmoud, Sharaf Baha', Abdel-Razeq Hikmat
Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, United States.
Department of Internal Medicine, Section of Hematology and Medical Oncology, King Hussein Cancer Center, Amman, Jordan.
Front Oncol. 2025 Jun 17;15:1435253. doi: 10.3389/fonc.2025.1435253. eCollection 2025.
Breast cancer, a leading cause of cancer-related deaths, prompts research into chemoprevention strategies. This narrative review explores risk factors, assessment tools, and summarizes the effectiveness and side effects of chemopreventive agents used for breast cancer risk reduction.
Published data from major clinical trials, meta-analyses, and data presented at major international conferences that addressed the utilization of tamoxifen, raloxifene, aromatase inhibitors (AI) and other potential drugs are reviewed. Risk assessments models utilized to assess women's risk of getting breast cancer are discussed, too.
Tamoxifen, a selective estrogen receptor modulator (SERM), demonstrated efficacy in reducing breast cancer risk in postmenopausal and premenopausal women. However, it poses several worrisome adverse events. Raloxifene, another SERM, has risk-reducing benefits with a better safety profile compared to tamoxifen. AI, like anastrozole and exemestane, reduced invasive breast cancer with better side effect profile. Denosumab, a monoclonal antibody that tackles receptor activator of nuclear factor kappa B (RANK-RANKL), is promising in preventing breast cancer in healthy carriers of pathogenic variants. Despite their proven efficacy, chemopreventive agents are underutilized underscoring the importance of raising the awareness of health care workers and women at-risk.
Chemopreventive agents present opportunities for reducing breast cancer risk. However, careful consideration of side effects and individual risk factors are crucial to enhance uptake rate. Further research is needed to compare the effectiveness of SERMs and AI in preventing breast cancer, especially in high-risk populations with pathogenic germline mutations.
乳腺癌是癌症相关死亡的主要原因之一，这促使人们对化学预防策略进行研究。本叙述性综述探讨了风险因素、评估工具，并总结了用于降低乳腺癌风险的化学预防药物的有效性和副作用。
回顾了来自主要临床试验、荟萃分析以及在主要国际会议上发表的数据，这些数据涉及他莫昔芬、雷洛昔芬、芳香化酶抑制剂（AI）和其他潜在药物的应用。还讨论了用于评估女性患乳腺癌风险的风险评估模型。
他莫昔芬是一种选择性雌激素受体调节剂（SERM），在降低绝经后和绝经前女性患乳腺癌风险方面显示出疗效。然而，它会引发一些令人担忧的不良事件。雷洛昔芬是另一种SERM，与他莫昔芬相比，具有降低风险的益处且安全性更好。阿那曲唑和依西美坦等AI可降低浸润性乳腺癌风险，副作用较小。地诺单抗是一种靶向核因子κB受体激活剂（RANK-RANKL）的单克隆抗体，在预防携带致病基因变异的健康人群患乳腺癌方面前景广阔。尽管化学预防药物已被证实有效，但未得到充分利用，这凸显了提高医护人员和高危女性认识的重要性。
化学预防药物为降低乳腺癌风险提供了机会。然而，仔细考虑副作用和个体风险因素对于提高使用率至关重要。需要进一步研究比较SERM和AI在预防乳腺癌方面的有效性，特别是在携带致病种系突变的高危人群中。
