Pharmacological Prevention in Breast Cancer: Current Evidence, Challenges, and Future Directions

Area of Science:

• Oncology
• Preventive Medicine
• Pharmacology

Background:

• Pharmacological prevention is a proven strategy for reducing hormone receptor-positive breast cancer incidence in high-risk women.
• Despite robust evidence from randomized trials, clinical adoption of breast cancer pharmacoprevention remains suboptimal.
• Low uptake necessitates a review of current strategies and exploration of novel approaches.

Purpose of the Study:

• To review the efficacy and safety of pharmacologic agents for breast cancer risk reduction.
• To examine clinical implementation challenges and explore emerging strategies for improving pharmacoprevention uptake.
• To summarize evidence on selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs).

Main Methods:

• Comprehensive literature review of pharmacologic agents for breast cancer risk reduction.
• Analysis of risk assessment models, clinical guidelines, and implementation barriers.
• Evaluation of emerging strategies, including low-dose therapies and digital decision aids.

Main Results:

• Tamoxifen, raloxifene, and aromatase inhibitors significantly decrease estrogen receptor-positive breast cancer incidence in high-risk groups.
• Adverse effects and limited awareness are key barriers to the use of current pharmacologic prevention.
• Personalized risk models, low-dose tamoxifen, digital health tools, SERDs, and GLP-1 receptor agonists show promise for enhancing acceptability and adherence.

Conclusions:

• Pharmacoprevention provides significant benefits for selected high-risk women.
• Future directions include developing new drugs, refining precision risk stratification, and enhancing individualized decision-making.
• Overcoming implementation barriers is crucial to maximize the impact of breast cancer preventive strategies.