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🌱 來自: breast cancer

Prevention-of-breast cancer

• Tamoxifen (TAM): Risk-benefit: 43% 7-y RR of invasive breast CA but ↑ DVT/PE, ↑ endometrial CA (NSABP P-1 (BCPT) JNCI 1998;90: 1371; Lancet 2002;360:817)
• Raloxifene: 76% as effective as tam for RR also ↓ vertebral fractures, ↑ risk of stroke, DVT/PE, cataracts but < tam (RUTH, NEJM 2006;355:125), trend toward ↓ uterine CA (NSABP P-2 (STAR), JAMA 2006;295:2727), FDA approved in postmenopausal women
• AIs: Exemestane & anastrozole are not FDA approved for chemoprevention, no prospective data on AIs vs. tam or raloxifene. 65% 3-y RR of invasive breast CA w/ exemestane (MAP.3, NEJM 2011;364:2381) & 50% 7-y RR of invasive breast CA w/ anastrozole in postmenopausal women vs. placebo (IBIS-2, Lancet 2014;383:1041)
• Prophylactic bilateral mastectomy: 90% breast CA risk reduction for women at ↣ high risk (ie, BRCA1/2, TP53) (JAMA 2010;304:967)
• Prophylactic bilateral salpingoophorectomy: ↓ ovarian CA risk by 85-90% & breast CA risk by approx 50% & decrease in all-cause + CA-specific mortality in high-risk women (BRCA1/2) (JAMA 2010;304:967)