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prevention of breast cancer
(if high-risk: eg, FHx, LCIS, atypical hyperplasia)
- Tamoxifen (contraindic. in preg): ↓ risk contralateral breast ca as adjuvant Rx. Approved for 1° prevent. if ↑ risk: ↓ invasive breast cancer, but ↑ DVT & uterine ca.
- Raloxifene (only if post-menopausal): ↓ risk of invas breast ca, vertebral fx, & uterine ca, ↑ risk stroke & DVT/PE (NEJM 2006;355:125); less effective than tamoxifen for prevention.
- Aromatase inhib. (post-menopausal): ↓ risk >50% (Lancet 2014;383:1041), ↑ osteoporosis
- BRCA1/2 ⊕: intensified surveillance vs. prophylactic bilat. mastectomy which ↓ risk ~90%; bilat. salpingo-oophorectomy ↓ risk of ovarian and breast cancer (NEJM 2016;374:454)
Explain by ChatGPT
- The first paragraph is discussing the prevention of breast cancer, specifically in high-risk individuals. Tamoxifen is mentioned as a possible preventative measure, but it is contraindicated in pregnancy. Raloxifene is another option for post-menopausal women, but it is less effective than tamoxifen. Aromatase inhibitors are also mentioned as a preventative measure for post-menopausal women.
The second paragraph discusses the different risks associated with tamoxifen and raloxifene. Tamoxifen may decrease the risk of breast cancer, but it can also increase the risk of DVT and uterine cancer. Raloxifene may decrease the risk of breast cancer, but it can also increase the risk of stroke and DVT/PE.
The third paragraph discusses the different options for preventing breast cancer in women who are BRCA1/2 positive. Intensified surveillance is one option, but prophylactic bilat mastectomy is more effective, reducing the risk by 90%. Bilat salpingo-oophorectomy can also reduce the risk of ovarian and breast cancer.
窩的英文不太好
第一段討論了乳腺癌的預防，特別是高危人群。提到他莫昔芬作為一種可能的預防措施，但它在懷孕期間是禁忌的。雷洛昔芬是絕經後婦女的另一種選擇，但效果不如他莫昔芬。芳香化酶抑製劑也被提及作為絕經後婦女的預防措施。
第二段討論了與他莫昔芬和雷洛昔芬相關的不同風險。他莫昔芬可降低患乳腺癌的風險，但也會增加深靜脈血栓和子宮癌的風險。雷洛昔芬可降低患乳腺癌的風險，但也會增加中風和 DVT/PE 的風險。
第三段討論了 BRCA1/2 陽性女性預防乳腺癌的不同選擇。強化監測是一種選擇，但預防性雙側乳房切除術更有效，可將風險降低 90%。雙側輸卵管卵巢切除術還可以降低患卵巢癌和乳腺癌的風險。