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Breast cancer chemoprevention. Tamoxifen: current issues and future prospective
R T Chlebowski1, J Butler, A Nelson
1UCLA School of Medicine, Department of Medicine, Torrance.
Abstract:
Intervention clinical trials are under way to address whether tamoxifen can prevent breast cancer development. This effort is based on laboratory evidence that tamoxifen interferes with the initiation and promotion of mammary cancer, clinical evidence of decreased breast cancer incidence in the opposite breast of women participating in tamoxifen adjuvant breast cancer trials, and a favorable toxicity profile of tamoxifen providing reasonable assurance of drug safety when used in a population without cancer. The apparently favorable effects of tamoxifen on lipid metabolism and bone mineral density provide additional impetus to this evaluation. Potentially life threatening toxicity of thromboembolism and development of a second cancer remain concerns. With respect to implications of such clinical trials, even upon successful study completion, difficult issues will remain; these issues include the potential for interaction between tamoxifen and dietary fat reduction (also proposed as potential breast cancer prevention), the cost and cost-effectiveness of wide scale (or selective) implementation of positive results, and the generalizability of study results to socioeconomically disadvantaged and racial and ethnic minority populations that historically have been under-represented in medical clinical trials. These important issues should be addressed concurrently as large-scale prevention trials go forward to optimize the practical utility of efficacy data obtained.
Insights
Tamoxifen shows promise in preventing breast cancer, supported by lab and clinical data. Ongoing trials evaluate its safety and effectiveness, considering potential risks and implementation challenges.
Area of Science:
- Oncology
- Preventive Medicine
- Pharmacology
Background:
- Tamoxifen is being investigated for breast cancer prevention.
- Evidence suggests tamoxifen may inhibit cancer initiation and promotion.
- Previous trials show reduced incidence in the contralateral breast of women using tamoxifen.
Purpose of the Study:
- To evaluate the efficacy of tamoxifen in preventing breast cancer.
- To assess the safety and toxicity profile of tamoxifen for preventive use.
- To explore the drug's effects on lipid metabolism and bone mineral density.
Main Methods:
- Intervention clinical trials are currently underway.
- Evaluation is based on laboratory evidence and existing clinical data.
- Safety is assessed considering potential adverse events like thromboembolism and secondary cancers.
Main Results:
- Tamoxifen demonstrates potential for breast cancer prevention.
- Favorable effects on lipid metabolism and bone density are noted.
- Concerns regarding life-threatening toxicities persist.
Conclusions:
- Tamoxifen is a viable candidate for breast cancer prevention trials.
- Further research must address interactions with other preventive strategies like diet.
- Cost-effectiveness and generalizability to diverse populations require careful consideration.