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Risk-Reducing (Chemopreventive) Agents in Breast Cancer Prevention

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Trends in Breast Cancer Prevention

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Abstract

The use of risk-reducing medications to prevent the development of malignant diseases has been promoted for more than 20 years. Successful examples have mostly involved the use of hormone antagonists and SERMs as well as anti-inflammatory drugs, and were mostly reserved for high risk patients.

In this chapter we discuss the current evidence available for the association between breast cancer and commonly used drugs suggested in the literature as carrying potential preventive activity against breast cancer in vitro, in animal models and in humans. These include vitamin D, bisphosphonates, statins and metformin, all of which are in use for a variety of non-cancer related indications.

While all of these compounds have shown a high level of anti-breast cancer activity, in one or more of the different experimental platforms, none have been shown to be preventive in randomized controlled trials (RCTs). Therefore these drugs have not been formally approved for actual use in prevention, in either average-risk or high-risk women. This might reflect the fact that it is extremely hard to use RCTs that employ medications that are in common use, because of a major bias that is introduced if one randomizes only the fraction of the population that is not already using the drug for other indications. However, a common use of these compounds by the population, if actually have a true preventive effect, would lead to reduction in incidence of breast cancer in the population at large by way of a “natural experiment”. The current reduction in breast cancer incidence and mortality seen in many western countries can actually be attributed, at least in part, to an inadvertent effect of these drugs.

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Authors and Affiliations

  1. Department of Community Medicine and Epidemiology and Clalit National Cancer Control Center, Carmel Medical Center and B. Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

    Naomi Gronich M.D. & Gad Rennert M.D., Ph.D.

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  1. Naomi Gronich M.D.
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Correspondence to Naomi Gronich M.D. .

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  1. The Irma H. Russo, MD, Breast Cancer Research Laboratory, Fox Chase Cancer Center--Temple Health, Philadelphia, Pennsylvania, USA

    Jose Russo

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Gronich, N., Rennert, G. (2016). Risk-Reducing (Chemopreventive) Agents in Breast Cancer Prevention. In: Russo, J. (eds) Trends in Breast Cancer Prevention. Springer, Cham. https://doi.org/10.1007/978-3-319-27135-4_8

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