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Prevention of Breast Cancer in Women at High RiskBY: Ritu Choudhary | Category: Breast Cancer | Submitted: 2010-06-27 07:52:19
Despite advances in the treatment of breast cancer the morbidity and mortality associated with this disease remain high. There is therefore a great interest in the primary prevention of breast cancer in women at high risk on the basis of family history or personal history. It appears from placebo-controlled studies including IBIS-I, NSABP-P1 than treatment with tamoxifen for 5 years in women with a high risk, reduces the risk breast cancer hormone receptor in situ and invasive. According to research work, the risks associated with tamoxifen (especially thromboembolic events and endometrial carcinoma) do not allow its use in primary prevention. Since then, the NSABP-P1 study with tamoxifen has been published, also with encouraging results and monitoring data of the study show that the preventive effect persists up to 2 years after stopping tamoxifen. Based on these studies, the use of tamoxifen in preventing breast cancer in women at high risk, i.e. primary prevention is indicated in the records in the United States. Research of this drug could be used in the prevention of breast cancer and hope for a better safety profile. Raloxifene, like tamoxifen is a selective modulator of estrogen receptors. Based on the study work, raloxifene is used in the treatment of osteoporosis. In this placebo-controlled study, a significant decrease in the risk of invasive breast cancer was also observed with raloxifene, but it was only a secondary endpoint. Since then, two large scale studies have been conducted with raloxifene, in which the invasive breast cancer was a primary endpoint. The results of these studies have been published recently. The STAR study, conducted in postmenopausal women at high risk of breast cancer, compared with raloxifene 60 mg and tamoxifen 20 mg for 5 years. Compared to tamoxifen, the following observations were made with raloxifene: no difference in the incidence of invasive breast cancer; increased incidence of breast cancer in situ, low incidence for endometrial cancer, lower incidence of thromboembolic events and cataracts, no difference in the incidence of other cancers, fractures, cardiac ischemia, stroke, total mortality and quality of life. The study, conducted in postmenopausal women with coronary artery disease or a history of multiple risk factors for coronary heart disease compared to raloxifene 60 mg and placebo for 5 years. Compared with placebo following findings were made with raloxifene: lowest incidence of invasive breast cancer. 170 women were being treated for five years by raloxifene instead of a placebo in preventing the occurrence of invasive breast cancer. The beneficial effect was observed both in women at high risk of breast cancer than among those not having such a risk, no difference in the incidence of breast cancer in situ, no difference in the incidence of coronary events, endometrial cancer, cataracts or total mortality, lower incidence of vertebral fractures, increased incidence of venous thromboembolism, cerebrovascular accidents with fatal outcome, hot flashes, cramps and peripheral ankles edema. With the inhibitors anastrozole and exemestane, placebo-controlled studies were started in postmenopausal women at high risk of breast cancer. Research has proved that tamoxifen, helps in preventing breast cancer and has a promising approach, but it is unclear to what extent these drugs reduces the risk of breast cancer in an individual. It is therefore difficult to encourage the routine use of tamoxifen or raloxifene in this indication. For a preventive treatment, there are no arguments to make a choice between tamoxifen and raloxifene. Both drugs reduced the risk of containing invasive breast cancer hormone receptor, tamoxifen seemed more effective in the prevention of breast cancer in-situ. The safety profile of raloxifene may be a little more favorable, but serious side effects like venous thromboembolism may occur with both drugs. Article Source: http://www.cancer-surgery.com/ About Author / Additional Info: I am not a cancer doctor. Always consult your doctor before taking any action or conclusion regarding your medical condition. Comments on this article: (0 comments so far)
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