Response and Resistance to the Endocrine Prevention of Breast Cancer

  • Anthony Howell
  • Nigel J. Bundred
  • Jack Cuzick
  • D. Craig Allred
  • Robert Clarke
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 617)

Current endocrine approaches to breast cancer (BC) prevention are targeted mainly at the estrogen receptor alpha (ERα) (1). Endocrine prevention depends upon either reducing the concentration of estrogen reaching ERα+ breast epithelial cells [estrogen deprivation (ED)] by, for example, ovarian suppression in premenopausal women, or aromatase inhibition in postmenopausal women, or by blocking the interaction of estrogen with ERα by selective estrogen receptor modulators (SERMs) such as tamoxifen (Tarn) and raloxifene (Ral). Observational studies (2–11) and randomised controlled trials (12–25) indicate that treatment by ED and SERMS reduces the risk of subsequent BC by approximately 50% and that this effect is prolonged (16, 18, 20, 26). In the human breast, ERα is detectable in epithelial cells of lobules and ducts and not in the stroma (27). However, it is not clear whether normal, premalignant or malignant epithelial cells are the targets for endocrine prevention. In this chapter, we summarise the results of endocrine prevention trials to date and what is known about the response of the three types of potential target structures to estrogen stimulation and inhibition by ED and SERMS.


Breast Cancer Breast Cancer Contralateral Breast Cancer Premalignant Lesion Endocrine Prevention 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer 2008

Authors and Affiliations

  • Anthony Howell
    • 1
  • Nigel J. Bundred
  • Jack Cuzick
    • 2
  • D. Craig Allred
  • Robert Clarke
    • 3
  1. 1.CRC Department Medical OncologyUniversity of Manchester Christie Hospital and Holt Radium Inst.ManchesterUK
  2. 2.Cancer Research UK Centre for Epidemiol., Mathematics, and StatisticsWolfson Institute of Preventive MedicineLondonUK
  3. 3.Breast Biology Group Division of Cancer StudiesUniversity of Manchester Christie Hospital (NHS) TrustManchester

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