NCCN currently recommends that all women with a life expectancy of at least 10 years and a Gail risk of 1.66% or higher be counseled about the availability, benefits, and risks of breast cancer preventive therapy.10 Tamoxifen has the most data supporting its efficacy in prevention, but raloxifene and exemestane are accepted alternatives. Exemestane appears to offer the most risk reduction, followed by tamoxifen, and raloxifene but the varying toxicity profiles and individual patient risk factors should be a part of treatment decision-making.. Progress in more precisely identifying women at risk, further elucidating risk to benefit ratios, and education should make this strategy more commonly and confidently used.


References


Continue Reading

1. American Cancer Society. Cancer Facts & Figures 2012. Atlanta: American Cancer Society; 2012.
2. Kinsinger LS, Harris RH, Woolf SH, Sox HC, Lohr KN. Chemoprevention of breast cancer: a summary of the evidence. Ann Intern Med. 2002;137(1):59-69.

3. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomized trials. Lancet. 2011;378(9793):771-784.

4. Cuzick J, DeCensi A, Arun B, et al. Preventive therapy for breast cancer: a consensus statement. Lancet Oncol. 2011;12(5):496-503.

5. Waters EA, McNeel TS, Stevens WM, Freedman AN. Use of tamoxifen and raloxifene for breast cancer chemoprevention in 2010. Breast Cancer Res Treat. 2012;134(2):875-880.

6. Zhang Y, Simondsen K, Kolesar JM. Exemestane for primary prevention of breast cancer. Am J Health Syst Pharm. 2012;69(16):1384-1388.

7. Goss PE, Ingle JN, Alés-Martínez J, et al. Exemestane for breast-cancer prevention in postmenopausal women. N Engl J Med. 2011;364(25):2381-2391.

8. National Cancer Institute. Breast cancer risk assessment tool. http://www.cancer.gov/bcrisktool/. Accessed March 24, 2013.

9. Vickers A. Prediction models in cancer care. CA Cancer J Clin. 2011;61(5):315-326.

10. National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Breast Cancer Risk Reduction; v1.2012. www.nccn.org. Accessed March 24, 2013.

11. Gabriel EM, Jatoi I. Breast cancer chemoprevention. Expert Rev Anticancer Ther. 2012;12(2):223-228.

12. Decensi A, Dunn BK, Puntoni M, Gennari A, Ford LG. Exemestane for breast cancer prevention: a critical shift? Cancer Discov. 2012;2(1):25-40.

13. Vogel VG, Costantino JP, Wickerham DL, et al. Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes. The NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA. 2006;295(23):2727-2741.

14. Vogel VG, Costantino JP, Wickerham DL, et al. Update of the National Surgical Adjuvant Breast and Bowel Project Study of Tamoxifen and Raloxifene (STAR) P-2 trial: preventing breast cancer. Cancer Prev Res. 2010;3(6):396-706.

15. Freedman AN, Yu B, Gail MH, et al. Benefit/risk assessment for breast cancer chemoprevention with raloxifene or tamoxifen for women age 50 years or older. J Clin Oncol. 2011;29(17):2327-2333.

16. Uray IP, Brown PH. Chemoprevention a hormone receptor-negative breast cancer: new approaches needed. Recent Results Cancer Res. 2011;188:147-162.

17. Cazzaniga M, Bonanni B. Breast cancer chemoprevention: old and new approaches. J Biomed Biotech. 2012a;IS985620 (doi:10.1155/2012/985620).

18. Anderson WF, Chatterjee N, Ershler WB, Brawley OW. Estrogen receptor breast cancer phenotypes in the Surveillance, Epidemiology, and End Results database. Breast Cancer Res Treat. 2002;76(1):27-36.

19. Cazzaniga M, Varricchio C, Montefrancesco C, Feroce I, Guerrieri-Gonzaga A. Fenretinide (4-HPR): a preventive chance for women at genetic and familial risk? J Biomed Biotech. 2012b;ID172897 (doi:10.1155/2012/172897).

20. Veronesi U, Mariani L, Decensi A, et al. Fifteen-year results of a randomized phase 3 trial of fenretinide to prevent second breast cancer. Ann Oncol. 2006;17(7):1065-1071.

21. Decensi A, Robertson C, Guerrieri-Gonzaga A, et al. Randomized double-blind 2X2 trial of low-dose tamoxifen and fenretinide for breast cancer prevention in high-risk premenopausal women. J Clin Oncol. 2009;27(23):3749-3756.

22. Ménard S, Camerini T, Mariani L, et al. Re: randomized trial of fenretinide to prevent second breast malignancy in women with early breast cancer. J Natl Cancer Inst. 2001;93(3):240-241.

23. Goodwin PJ, Stambolic V. Obesity and insulin resistance in breast cancer—chemoprevention strategies with a focus on metformin. Breast. 2011;20(Suppl 3):S31-S35.

24. Kumar AS, Benz CC, Shim V, et al. Estrogen receptor-negative breast cancer is less likely to arise among lipophilic statin users. Cancer Epidemiol Biomarkers Prev. 2008;17(5):1028-1033.

25. Woditschka S, Habel LA, Udaltsova N, et al. Lipophilic statin use and risk of breast cancer subtypes. Cancer Epidemiol Biomarkers Prev. 2010;19(10):2479-2487.

26. Wang J, Scholtens D, Holko M, et al. Lipid metabolism genes in contralateral unaffected breast and estrogen receptor status of breast cancer. Cancer Prev Res. 2013;Mar 19 [epub ahead of print]
.
27. Kaplan CP, Kim SE, Wong ST, et al. Willingness to use tamoxifen to prevent breast cancer among diverse women. Breast Cancer Res Treat. 2012;133(1):357-366.