Chemoprevention In Hereditary Breast And Ovarian Cancer Syndrome

Women who desire risk reduction intervention for breast cancer have the option of chemoprevention with tamoxifen therapy (20 mg/day for 5 years) or prophylactic surgery. The National Surgical Adjuvant Breast and Bowel Project prevention trial in healthy women 35 years and older with a 1.7% or greater cumulative 5-year risk for developing breast cancer demonstrated short-term reduction in risk of developing estrogen-receptor-positive breast cancer by 49%. The utility of tamoxifen for breast cancer risk reduction in women under the age of 35 years is unknown and current evidence-based data regarding tamoxifen breast cancer risk reduction in BRCA gene mutation carriers are insufficient. Women with BRCA1 mutations who develop breast cancer have estrogen-receptor-negative tumors in approximately 80% of cases, whereas women with BRCA2 mutations who develop breast cancer have estrogen-receptor-positive tumors in 80% of cases. Therefore, the use of tamoxifen for breast cancer prevention in BRCA1-mutation carriers cannot be routinely recommended, whereas it appears to be a reasonable choice for risk reduction in BRCA2-mutation carriers based on current evidence. The incidence of contralateral breast cancer in BRCA-mutation carriers was shown to be reduced by 50% with tamoxifen use,[7] by 60% after chemotherapeutic treatment of the first breast cancer,[7] and by 58% after bilateral oophorectomy.[7,8]

The use of oral contraceptive pills (OCP) as chemo-prevention in ovarian cancer has been extensively studied. It has been estimated that there is an overall risk reduction of approximately 40%[9] and that more than half of all ovarian cancer in the United States could be prevented by the use of oral contraceptive pills for at least 4 or 5 years.[10,11] However, the role of chemoprevention against ovarian cancer in HBOC syndrome is unknown. There have been conflicting reports on the impact of OCP use on breast and ovarian cancer risk in BRCA-mutation carriers.[12-15]

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