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Thursday, October 18, 2018 
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Breast Cancer Chemoprevention: What and When?

April-June 2017, Volume 12, Number 2
Isabel Lorenzo-Lorenzo, Isaura Fernández-Pérez, Ana Alonso-Herrero and Ma.José Villanueva-Sil
Oncology Department, University Hospital Complex of Vigo, Alvaro-Cunqueiro Hospital, Vigo, Spain

Cancer primary prevention includes all measures aimed at preventing the appearance of a disease or a health problem by controlling causal factors as well as predisposing or conditioning ones. With this in mind, breast cancer, the most prevalent malignancy in women, has been extensively investigated, including the administration of certain exogenous substances to slow, block, or even reverse progression to invasive cancer, intervention referred as chemoprevention. Intensive research has been carried out in this field, with a wide variety of drugs being studied and thousands of healthy women being included. Several well-known clinical practice guidelines have endorsed these results, concluding the convenience of offering, or at least discussing, the benefit of chemoprevention with women at high risk or above average risk of developing breast cancer, respectively. Moreover, several publications have hypothesized on the reasons for the low adoption rate of these recommendations, while addressing possible solutions to solve those barriers. The most comprehensive analysis published to date on the potential benefits of chemoprevention has been a recent Cochrane review. It includes 48 randomized controlled trials with 21 chemicals tested and 271,161 healthy women included. Their conclusion is far less optimistic than that of previous studies and meta-analyses, which have, on the one hand, focused mainly on the decrease of incident breast cancer cases rather than on the mortality rate reduction. On the other hand, factors such as side effects on healthy women, the degree of therapeutic compliance in real-world practice, and reasons for dropouts should be taken into account. To date, only two of the tested drugs have been approved by the FDA for breast cancer chemoprevention, as compared to no authorization for that purpose by the European Medicines Agency. The present article reviews the most relevant publications to redefine the true usefulness of breast cancer chemoprevention, which has been, not surprisingly, the subject of debate for over two decades

Key words:
Cancer prevention. Breast cancer prevention. Chemoprevention. Endocrine therapy. Selective estrogen-receptor modulators. Aromatase inhibitors. Clinical practice guidelines for breast cancer prevention. Meta-analysis. Network meta-analysis. Risk-reducing medication for primary breast cancer. Hereditary breast cancer. BRCA1. BRCA2.
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