July 2003 · Vol. 15, No. 7Reducing the risk of breast cancer: Key trials and their impact on practice
An expert sifts the data regarding chemopreventive options and expands on current guidelines for endometrial cancer screening of tamoxifen users.
STEVEN
R.
GOLDSTEIN,
MDDr. Goldstein is professor, obstetrics and gynecology, New York University School of Medicine; and director, gynecologic ultrasound, and codirector, bone densitometry, New York University Medical Center,
New York, NY.
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KEY POINTS
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In the Breast Cancer Prevention Trial, women taking tamoxifen experienced a 49% overall reduction in invasive breast cancer; the relative risk of endometrial cancer was 4.01 for women over 50 and 1.21 for women younger than 50.
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The risk of serious adverse effects with tamoxifen use appears to be lower in women under age 50.
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Preclinical animal data suggest that, like tamoxifen, raloxifene has potent antiestrogen effects on breast tissue.
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Because aromatase inhibitors block the peripheral conversion of androstenedione to estrogens, they inhibit both initiation and promotion of breast cancer. Thus, they may be more effective than selective estrogen receptor modulators in preventing the disease.
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More than 28,000 additional breast cancers could be prevented over 5 years if all eligible women were given tamoxifen.1
This is just one of several important findings highlighted in the studies covered in this review of breast cancer risk assessment and chemopreventive options.
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