Ford L G, Brawley O W, Perlman J A, Nayfield S G, Johnson K A, Kramer B S
Detection and Community Oncology Program, National Cancer Institute, Bethesda, Maryland 20892.
Cancer. 1994 Nov 1;74(9 Suppl):2726-33. doi: 10.1002/1097-0142(19941101)74:9+<2726::aid-cncr2820741823>3.0.co;2-s.
Breast and prostate cancer are significant causes of morbidity and mortality and are very similar in etiology, epidemiology, and modalities of treatment. Investigational strategies in the prevention of these malignancies also have strong parallels. The National Cancer Institute is sponsoring several large scale clinical trials involving hormonal manipulation and cancer prevention. In the Breast Cancer Prevention Trial, 16,000 women at high risk for breast cancer are being randomized to receive the antiestrogen agent tamoxifen or placebo for 5 years in an effort to determine if breast cancer development can be inhibited. In a similar trial, the Prostate Cancer Prevention Trial, 18,000 men older than 55 years of age will be randomized to receive finasteride, a 5-alpha-reductase inhibitor, or placebo to determine if inhibition of dihydrotestosterone synthesis in the prostate over a prolonged period will lead to a decreased incidence of prostate cancer. Both clinical trials offer the possibility of demonstrating that a hormonal intervention can decrease an individual's risk of developing breast or prostate cancer. They also have the potential of providing critical information about cancer risk, etiology, screening, and genetics, as well as quantifying the risks and benefits of specific preventive interventions.
乳腺癌和前列腺癌是发病和死亡的重要原因，在病因、流行病学及治疗方式上极为相似。预防这些恶性肿瘤的研究策略也有很多相似之处。美国国立癌症研究所正在资助几项涉及激素调控与癌症预防的大规模临床试验。在乳腺癌预防试验中，16000名乳腺癌高危女性被随机分为两组，一组接受抗雌激素药物他莫昔芬治疗，另一组接受安慰剂治疗，为期5年，以确定是否能抑制乳腺癌的发生。在一项类似的试验——前列腺癌预防试验中，18000名55岁以上的男性将被随机分为两组，一组接受5α-还原酶抑制剂非那雄胺治疗，另一组接受安慰剂治疗，以确定长期抑制前列腺中二氢睾酮的合成是否会导致前列腺癌发病率降低。这两项临床试验都有可能证明激素干预能够降低个体患乳腺癌或前列腺癌的风险。它们还有可能提供有关癌症风险、病因、筛查及遗传学的关键信息，同时量化特定预防干预措施的风险和益处。
