Use of risk determinants for different breast cancer prevention strategies

Almost all of the factors which are known to be associated with a high risk of breast cancer, other than high genetic risk, are associated with increased exposure to oestrogens. Thus, therapeutic manoeuvres targeted at oestrogen deprivation which have shown value in established breast cancers are attractive candidates for breast cancer prevention strategies. It is possible that such agents may reduce the incidence of ER-negative as well as ER-positive tumours. The potential use of these different drugs is restricted by menopausal status, e.g. aromatase inhibitors only after the menopause, and Gonadotropin-releasing hormone (GnRH) agonists prior to the menopause. There is a complex interplay between the anticipated benefit which may be derived from a respective agent and the side-effects associated with it. This article seeks to integrate the information from several sources and concludes that the prophylactic strategies should differ according to different risk profiles.