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Future possibilities in the prevention of breast cancer: Luteinizing hormone-releasing hormone agonists
Darcy V Spicer, Malcolm C Pike
Breast Cancer Research , 2000, DOI: 10.1186/bcr67
Abstract: More than a decade ago Pike et al [1] first suggested a potential role for agonists of LHRH to prevent breast cancer. The rationale for considering LHRH agonists is due to their ability to suppress ovarian function and sex steroid production; the reduction in sex steroids is predicted to lead to the prevention of breast cancer.Ovarian hormones (estrogens and progestogens) are critical factors in the genesis of human breast cancer. During the premenopausal years breast cancer risk increases steeply, but after cessation of ovarian function (menopause) it increases at a much lower rate. Epidemiologic studies have clearly demonstrated that early menopause, whether natural or artificial (bilateral oophorectomy), substantially reduces breast cancer risk. Menopause before age 35 years is associated with a 60-75% reduction in breast cancer risk [2,3,4,5,6]. The calculated effect of an early oophorectomy on the age-incidence curve of breast cancer is given in Figure 1; age at menopause determines the transition point from the steeply rising premenopausal slope to the more gentle postmenopausal slope. The protective effect of oophorectomy on breast cancer risk has recently been shown in women carrying BRCA1 germline mutations. Bilateral prophylactic oophorectomy (done to prevent ovarian cancer) is associated with a reduction in breast cancer risk [7]. The magnitude of the protection reported by Rebbeck et al [7] is substantial (hazard ratio of 0.53) and increased with increasing duration of follow up after the prophylactic surgery.The effect of ovarian hormones on breast cancer risk is predictable in light of the effects of these hormones on breast epithelial cell proliferation. Cell proliferation is central to the process of carcinogenesis, and agents that increase cell proliferation increase the incidence of random mutations and hence cancer risk [8]. In the normal human breast epithelial cell, both estrogens and progestogens are mitogens (for review [9]), hence oophorectom
The molecular basis of breast cancer prevention and treatment
Charles Streuli
Breast Cancer Research , 2004, DOI: 10.1186/bcr908
Abstract: José and Irma Russos' new book on the Molecular Basis of Breast Cancer: Prevention and Treatment tackles the problem by following a logical path of first introducing the disease from the epidemiological point of view, before discussing how the breast develops and becomes altered in cancer, and how we might seek to understand it through both in vivo and culture models. The book ends with two chapters on possible modalities for how the disease might be inhibited in the first place. Some of these are very interesting, and I particularly liked the chapters on Epidemiological considerations; the first half of the one on The (human) breast as a developing organ, where relatively few studies have been published in comparison to the mouse; and the chapter on Preventive strategies, which delves into the structure and activities of many naturally-occurring chemopreventives as well as anti-inflammatories, anti-estrogens, and other compounds that are likely to have properties to protect against the onset of cancer.The central idea in the book comes from the observation that early pregnancy protects against breast cancer, and posits that a treatment to artificially induce differentiation within mammary epithelial cells could represent a radical new approach to prevent much of the disease. The epidemiological data from which this hypothesis arises is supported strongly by experimental observations that a state of pregnancy induced naturally, or by estrogen/progesterone treatment, or by human chorionic gonadotropin (hCG, a hormone that stimulates ovaries to produce higher levels of estrogen and progesterone) has a dramatic inhibitory effect on carcinogen-induced mammary cancer. The authors argue a case for ectopic administration of hCG as a possible preventative strategy. However, although this might be a neat strategy for eliminating tumours in rats, it is rather premature to consider it as preventative in humans. The likely targets for neoplastic genomic modifications are breast
Pregnancy and its role in breast cancer
Filipe Correia Martins,Maria Filomena Botelho,Mafalda Laranjo,António Manuel Cabrita
Oncology Reviews , 2011, DOI: 10.4081/121
Abstract: Early full-term pregnancy is the only recognized factor able to prevent breast cancer. There are several hypotheses to explain the mechanisms of this protection, namely an altered hormonal milieu, a differentiation process or a switch in stem cell properties. To explore them, authors have been using animal models, mainly in rodents. Hormonal administration with estrogen and progesterone was the most widely used process to mimic the mammary changes during pregnancy. We have recently proposed that this enigmatic protective role of a full-term birth in breast cancer is carried out by tumor inhibition mediated by differentiated mammary epithelial cells. This explanation may give a new perspective of breast cancer prevention and treatment.
Future possibilities in the prevention of breast cancer: Role of genetic variation in breast cancer prevention
Heather Spencer Feigelson, Brian E Henderson
Breast Cancer Research , 2000, DOI: 10.1186/bcr69
Abstract: The traditional view of public health prevention strategies considers three broad categories. Primary prevention involves activities that are aimed at reducing and removing agents that increase risk. Secondary prevention includes early detection activities that are designed to reduce mortality. Finally, tertiary prevention aims to minimize or reduce long-term disability and suffering. Cancer prevention usually implies activities involved in primary or secondary prevention. For many cancer sites, we have made significant contributions in prevention. For example, the Pap smear has had a great impact on cervical cancer, and refrigeration and other safe food preservation practices have markedly reduced the incidence of stomach cancer. Largely because of the underlying hormonal etiology, however, primary prevention strategies for breast cancer have been limited.The biggest determinants of breast cancer risk are related to endogenous hormone levels and major reproductive events, and thus do not lend themselves to traditional prevention strategies. Table 1 lists the established breast cancer risk factors. Those with the greatest impact on risk are listed first, and unfortunately are the most difficult to modify by traditional public health measures. For example, surgical removal of the ovaries can hasten the onset of menopause, but is not considered a reasonable approach to reduce the risk of breast cancer. Age at menarche and the establishment of regular menstrual cycles may be delayed by vigorous physical activity and possibly diet, but rarely is breast cancer prevention a concern before menarche occurs.Limiting the use of alcohol, hormone replacement therapy (HRT), and oral contraceptives may reduce the risk of breast cancer, but the impact of these factors on breast cancer risk are modest. Furthermore, these agents have significant beneficial effects on the risks of other chronic diseases, and these risk-benefit ratios must be carefully weighed. Prolonged lactation may
Pregnancy and delivery after the breast carcinoma
Gruji?-Miljkovi? Zorica,Dobanova?ki-Miljkovi? Ljiljana,Gruji? Ilija
Archive of Oncology , 2003, DOI: 10.2298/aoo0302103g
Abstract: The planned pregnancy in patients treated for breast cancer was earlier inconceivable for oncologists and gynecologists. Our study presented a case of pregnancy after the patient had been operated and irradiated for breast cancer.
An investigation of breast cancer risk factors in Cyprus: a case control study
Andreas Hadjisavvas, Maria A Loizidou, Nicos Middleton, Thalia Michael, Rena Papachristoforou, Eleni Kakouri, Maria Daniel, Panayiotis Papadopoulos, Simon Malas, Yiola Marcou, Kyriacos Kyriacou
BMC Cancer , 2010, DOI: 10.1186/1471-2407-10-447
Abstract: We carried out a case-control study, involving 1,109 breast cancer patients and a group of 1,177 controls who were recruited while participating in the National screening programme for breast cancer. Information on demographic characteristics and potential risk factors were collected from both groups during a standardized interview. Logistic regression analysis was used to assess the strength of the association between each risk factor and breast cancer risk, before and after adjusting for the possible confounding effect of other factors.In multivariable models, family history of breast cancer (OR 1.64, 95% CI 1.23, 2.19) was the strongest predictor of breast cancer risk in the Cypriot population. Late menarche (OR 0.64, 95% CI 0.45, 0.92 among women reaching menarche after the age of 15 vs. before the age of 12) and breastfeeding (OR 0.74, 95% CI 0.59, 0.92) exhibited a strong protective effect. In the case of breastfeeding, the observed effect appeared stronger than the effect of pregnancy alone. Surprisingly, we also observed an inverse association between hormone replacement therapy (HRT) although this may be a product of the retrospective nature of this study.Overall the findings of our study corroborate with the results of previous investigations on descriptive epidemiology of risk factors for breast cancer. This investigation provides important background information for designing detailed studies that aim to improve our understanding of the epidemiology of breast cancer in the Cypriot population, including the study of gene-environment interactions. Furthermore, our study provides the first scientific evidence for formulating targeted campaigns for prevention and early diagnosis of breast cancer in Cyprus.Breast cancer is the most frequent malignancy in the female population of Europe and North America where an estimated 1 in 9 women are at risk of developing the disease [1]. Numerous epidemiological studies over the last three decades have revealed a number
Breast Cancer In Pregnancy: Management Approach
E. S. Garba, P. Uyanne, A. O. Oguntayo, S. Lafia, N. O. Udezue
Nigerian Journal of Surgical Research , 2001,
Abstract: About 1-2% of breast cancers occur during pregnancy and lactation, and 7% of fertile women have one or more pregnancies after mastectomy for breast cancers. The high physiological activity of the breast in pregnancy causes the breast to be engorged. There is increased vascularity and lymphatic drainage from the pregnant breast assisting the spread of metastatic process to the regional lymph nodes. The clinical features of cancers of the breast in pregnancy are the same as in the non-pregnant patient. Pregnant patients tend to have a higher incidence of positive lymph nodes, however. Early diagnoses is made possible with awareness of this condition during pregnancy, routine self examination, adequate history, meticulous examination with liberal use of fine needle aspiration biopsy and when necessary open biopsy under local anaesthesia. As in non-pregnant patients all modalities of treatments are intelligently employed in the treatment of breast cancer in pregnancy. Radical mastectomy is well tolerated during pregnancy, and the results of treatment during pregnancy are the same, stage for stage as in the non-pregnant woman. The reported overall survival rate for breast cancer in pregnancy is poor, reflecting the more advanced stage of the disease at diagnosis. An approach to the management of breast cancer in pregnancy is presented by a case illustration and a review of literature. (Nig J Surg Res 2001; 3: 111 – 117) KEY WORDS: Breast Cancer, Pregnancy, Management
Pregnancy associated breast cancer and pregnancy after breast cancer treatment  [cached]
Emek Do?er,Eray ?al??kan,Peter Mallmann
Journal of the Turkish-German Gynecological Association , 2011,
Abstract: Breast cancer is one of the most common cancers diagnosed during pregnancy and its frequency is increasing as more women postpone their pregnancies to their thirties and forties. Breast cancer diagnosis during pregnancy and lactation is difficult and complex both for the patient and doctors. Delay in diagnosis is frequent and treatment modalities are difficult to accept for the pregnant women. The common treatment approach is surgery after diagnosis, chemotherapy after the first trimester and radiotherapy after delivery. Even though early stage breast cancers have similar prognosis, advanced stage breast cancers diagnosed during pregnancy and lactation have poorer prognosis than similar stage breast cancers diagnosed in non-pregnant women. Women who desire to become pregnant after treatment of breast cancer will have many conflicts. Although the most common concern is recurrence of breast cancer due to pregnancy, the studies conducted showed that pregnancy has no negative effect on breast cancer prognosis. In this review we search for the frequency of breast cancer during pregnancy, the histopathological findings, risk factor, diagnostic and treatment modalities. We reviewed the literature for evidence based findings to help consult the patients on the outcome of breast cancer diagnosed during pregnancy and lactation, and also inform the patients who desire to become pregnant after breast cancer according to current evidences.
The Professional Medical Journal , 2009,
Abstract: Pregnancy associated breast carcinoma is an entity which is diagnosed during pregnancy or within one year postpartum. Objective: (1) To understand the pathogenesis of pregnancy associated breast carcinoma. (2) To be able to manage this problem most effectively in the interest of fetus & mother. (3) To be able to avoid preventable complications of treatment. Conclusions: The pregnancy associated breast carcinoma can be managed effectively with various treatment modalities during various stages of pregnancy & lactation. Prognosis & outcome: It is not worse than the stage wise carcinoma breast in non pregnant women of the same age.
Prevention and Treatment of Bone Metastases in Breast Cancer  [PDF]
Ripamonti Carla,Trippa Fabio,Barone Gloria,Maranzano Ernesto
Journal of Clinical Medicine , 2013, DOI: 10.3390/jcm2030151
Abstract: In breast cancer patients, bone is the most common site of metastases. Medical therapies are the basic therapy to prevent distant metastases and recurrence and to cure them. Radiotherapy has a primary role in pain relief, recalcification and stabilization of the bone, as well as the reduction of the risk of complications (e.g., bone fractures, spinal cord compression). Bisphosphonates, as potent inhibitors of osteoclastic-mediated bone resorption are a well-established, standard-of-care treatment option to reduce the frequency, severity and time of onset of the skeletal related events in breast cancer patients with bone metastases. Moreover bisphosphonates prevent cancer treatment-induced bone loss. Recent data shows the anti-tumor activity of bisphosphonates, in particular, in postmenopausal women and in older premenopausal women with hormone-sensitive disease treated with ovarian suppression. Pain is the most frequent symptom reported in patients with bone metastases, and its prevention and treatment must be considered at any stage of the disease. The prevention and treatment of bone metastases in breast cancer must consider an integrated multidisciplinary approach.
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