The prevention of breast cancer

Background: Despite advances in the early detection and treatment of breast carcinoma, the mortality and morbidity rates associated with this disease remain high. Primary prevention, therefore, offers the best chance of making a major impact on outcome. Methods: The aim was to review the rationale,...

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Bibliographic Details
Published in:British journal of surgery 2003-07, Vol.90 (7), p.772-783
Main Authors: Prichard, R. S., Hill, A. D. K., Dijkstra, B., McDermott, E. W., O'Higgins, N. J.
Format: Article
Language:English
Subjects:
Antineoplastic Agents, Hormonal - therapeutic use
Biological and medical sciences
Breast Neoplasms - diet therapy
Breast Neoplasms - prevention & control
Breast Neoplasms - surgery
Clinical Trials as Topic
Cyclooxygenase Inhibitors - therapeutic use
Double-Blind Method
Estrogen Antagonists - therapeutic use
Female
Forecasting
Genes, BRCA1
Genes, BRCA2
Gynecology. Andrology. Obstetrics
Humans
Mammary gland diseases
Medical sciences
Raloxifene Hydrochloride - therapeutic use
Randomized Controlled Trials as Topic
Retinoids - therapeutic use
Tamoxifen - therapeutic use
Tumors
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Summary:Background: Despite advances in the early detection and treatment of breast carcinoma, the mortality and morbidity rates associated with this disease remain high. Primary prevention, therefore, offers the best chance of making a major impact on outcome. Methods: The aim was to review the rationale, current stage of development and adverse effects of the strategies involved in the primary prevention of breast carcinoma. A review of the literature was undertaken by searching the MEDLINE database for the period 1966–2002 without language restrictions. Results and conclusion: Currently, the only agent to have general approval for chemoprevention of breast carcinoma is tamoxifen. Women who derive the greatest benefit in terms of risk reduction from tamoxifen are premenopausal with a 5‐year Gail risk factor of more than 1·66 per cent, postmenopausal with a 5‐year Gail risk factor of more than 3 per cent, and postmenopausal without a uterus. In these specific subgroups, tamoxifen should be considered for the chemoprevention of breast carcinoma. Raloxifene, retinoids, aromatase inhibitors and cyclo‐oxygenase 2 inhibitors require further clinical investigation before adoption in this context. Surgical intervention should largely be limited to those women who have a BRCA1 or BRCA2 mutation. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Although tamoxifen is the only generally approved agent, others are under evaluation
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.4218