This E-learning module elaborates on key elements in cancer preventive medicine from the aspect of chemo-endocrine prevention of breast cancer. Such paradigm implies the use of natural or pharmacological agents that are effective for individuals, based on biomarker response and better identification of cohorts at high risk.
It is a frequently neglected area for many medical oncologists, and the author of this Module, a world renowned European expert in cancer prevention, provides the essential postulates, goals of prevention, drugs, clinical studies, crucial issues for future research and ultimately advocates to learn from the cardiologists that identification of individuals at high risk and use of prophylactic treatments are a better strategy than passively waiting for the disease to appear. He expresses his hope that such paradigm shift will hopefully find increasing interest among the young generations of medical oncologists.
The author starts by presenting common misinterpretations in cancer prevention. Furthermore, he provides a range of cancers and drugs that have shown reduced cancer incidence in phase III studies. He provides the latest overview of five-year follow-up findings from selective oestrogen receptor modulators (SERMs) in 9 double blind trials in women at high risk for breast cancer and osteoporotic women. Moreover, he illustrates the findings from two recent clinical studies, the NCIC CTG MAP3 prevention trial of exemestane and the International Breast cancer Intervention Study II (IBIS-II) of anastrozole that have provided evidence for a remarkable effect of aromatase inhibitors in breast cancer prevention.
He further focuses on specific primary breast cancer risk reduction recommendations from different clinical guidelines, risk factor models, as well as future issues in breast cancer prevention.
The author’s conclusion is that a crucial issue for the future will be the validation of efficacy biomarkers that allow an early selection of responders versus non-responders. He underlines that with the increasing costs of cancer therapy, there is a reason for optimism that inexpensive preventive therapy for women at high risk will become a key strategy for global breast cancer control.
