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Progress in the prevention of breast cancer: concept to reality
1Robert H. Lurie Comprehensive Cancer Center, Northwestern University Medical School, 303 E. Chicago Avenue, 60611, Chicago, IL, USA. vcjordan@nwu.edu
Abstract:
In 1936, Professor Antoine Lacassagne suggested that breast cancer could be prevented by developing drugs to block estrogen action in the breast. Jensen discovered the physiologic target, the estrogen receptor, that regulates estrogen action in its target tissues and Lerner discovered the first nonsteroidal antiestrogen MER25. However, the success of tamoxifen as a treatment of breast cancer opened the door for the testing of the worth of tamoxifen to reduce breast cancer incidence in high-risk women. In 1998, Fisher showed that tamoxifen could reduce breast cancer incidence by 50%. Nevertheless, only half the women who develop breast cancer have risk factors other than age, so what can be done for women without risk factors? The recognition that nonsteroidal antiestrogens have the ability to modulate estrogen action selectively has advanced the design and development of new drug for multiple diseases. Tamoxifen and raloxifene maintain bone density and raloxifene is now used to prevent osteoporosis and is being tested as a preventive for coronary heart disease and breast cancer. The drug group is now known as selective estrogen receptor modulators (SERMs) and the challenge is to design new agents for multiple applications. If the 20th century was the era of chemotherapy, the 21st century will be the era of chemoprevention.
Insights
Selective estrogen receptor modulators (SERMs) offer promising chemoprevention strategies for breast cancer. These drugs, like tamoxifen and raloxifene, selectively modulate estrogen action, reducing cancer incidence and preventing osteoporosis.
Area of Science:
- Oncology
- Endocrinology
- Pharmacology
Background:
- Early 20th-century research proposed blocking estrogen to prevent breast cancer.
- Discovery of the estrogen receptor and nonsteroidal antiestrogens paved the way for targeted therapies.
- Tamoxifen's success in treating breast cancer led to its investigation for prevention in high-risk women.
Purpose of the Study:
- To explore the potential of selective estrogen receptor modulators (SERMs) for breast cancer chemoprevention.
- To address the need for preventive strategies in women without traditional risk factors.
- To highlight the evolution from chemotherapy to chemoprevention in the 21st century.
Main Methods:
- Review of historical research and clinical trials on antiestrogens and SERMs.
- Analysis of tamoxifen's efficacy in reducing breast cancer incidence.
- Examination of SERMs' effects on bone density and cardiovascular health.
Main Results:
- Tamoxifen demonstrated a 50% reduction in breast cancer incidence in high-risk women.
- SERMs like tamoxifen and raloxifene maintain bone density.
- Raloxifene is used for osteoporosis prevention and investigated for cardiovascular disease and breast cancer prevention.
Conclusions:
- SERMs represent a significant advancement in breast cancer chemoprevention.
- The development of novel SERMs is crucial for broader disease prevention.
- The 21st century is characterized by a shift towards chemoprevention strategies.