Breast cancer chemoprevention: The saga of underuse continues
Menée auprès de 3 919 femmes incluses dans une cohorte américano-portoricaine comportant 50 884 participantes ayant au moins une soeur atteinte d'un cancer du sein (âge : de 35 à 74 ans), cette étude identifie les caractéristiques individuelles associées à l'utilisation ou à l'arrêt du tamoxifène dans le cadre d'une chimioprévention du cancer du sein, puis estime la proportion des patientes pour lesquelles le rapport bénéfices/risques du tamoxifène est favorable
The American Cancer Society estimates that there will be 232670 Americans diagnosed with invasive breast cancer this year (1). Several large, well-conducted studies provide Level I evidence that therapies are available to reduce that figure, but they have thus far been underutilized (2).
In this issue of the Journal, Nichols et al. report on the use of tamoxifen among 50884 women who entered the Sister Study, all of whom were required to have at least one sister diagnosed with breast cancer. Only 1046 reported ever taking tamoxifen for breast cancer chemoprevention. In the substudy of those who did, there were only three women (under age 50 years) who showed no evidence of net benefit.
Although current chemoprevention options are not perfect, there are women who could benefit now and avoid the diagnosis of breast cancer.
In 1999, Gail et al. demonstrated a net benefit and no increase in the risks of either endometrial cancer or clotting in all premenopausal women with a five-year risk of breast cancer greater than 1.67% (4).
It is of note that 25 women with lobular carcinoma …
Journal of the National Cancer Institute , commentaire, 2014