Retour
Article pour les cliniciens

L'utilisation de médicaments pour réduire le risque de cancer du sein primaire : une revue systématique de la U.S. Preventive Services Task Force.



  • Nelson HD
  • Smith ME
  • Griffin JC
  • Fu R
Ann Intern Med. 2013 Apr 16;158(8):604-14. doi: 10.7326/0003-4819-158-8-201304160-00005. (Review)
PMID: 23588749
Lire le résumé Lire résumé des données probantes Lire le texte intégral
Disciplines
  • Santé publique
    Relevance - 6/7
    Intérêt médiatique  - 5/7
  • Médecine familiale (MF)/Médecine générale (MG)
    Relevance - 5/7
    Intérêt médiatique  - 4/7
  • Médecine interne générale - Soins primaires
    Relevance - 5/7
    Intérêt médiatique  - 4/7
  • Oncology - Breast
    Relevance - 4/7
    Intérêt médiatique  - 4/7

Résumé (en anglais)

BACKGROUND: Medications to reduce risk for primary breast cancer are recommended for women at increased risk; however, use is low.

PURPOSE: To update evidence about the effectiveness and adverse effects of medications to reduce breast cancer risk, patient use of such medications, and methods for identifying women at increased risk for breast cancer.

DATA SOURCES: MEDLINE and Cochrane databases (through 5 December 2012), Scopus, Web of Science, clinical trial registries, and reference lists.

STUDY SELECTION: English-language randomized trials of medication effectiveness and adverse effects, observational studies of adverse effects and patient use, and diagnostic accuracy studies of risk assessment.

DATA EXTRACTION: Investigators independently extracted data on participants, study design, analysis, follow-up, and results, and a second investigator confirmed key data. Investigators independently dual-rated study quality and applicability using established criteria.

DATA SYNTHESIS: Seven good- and fair-quality trials indicated that tamoxifen and raloxifene reduced incidence of invasive breast cancer by 7 to 9 cases in 1000 women over 5 years compared with placebo. New results from STAR (Study of Tamoxifen and Raloxifene) showed that tamoxifen reduced breast cancer incidence more than raloxifene by 5 cases in 1000 women. Neither reduced breast cancer-specific or all-cause mortality rates. Both reduced the incidence of fractures, but tamoxifen increased the incidence of thromboembolic events more than raloxifene by 4 cases in 1000 women. Tamoxifen increased the incidence of endometrial cancer and cataracts compared with placebo and raloxifene. Trials provided limited and heterogeneous data on medication adherence and persistence. Many women do not take tamoxifen because of associated harms. Thirteen risk-stratification models were modest predictors of breast cancer.

LIMITATION: Data on mortality and adherence measures and for women who are nonwhite, are premenopausal, or have comorbid conditions were lacking.

CONCLUSION: Medications reduced the incidence of invasive breast cancer and fractures and increased the incidence of thromboembolic events. Tamoxifen was more effective than raloxifene but also increased the incidence of endometrial cancer and cataracts. Use is limited by adverse effects and inaccurate methods to identify candidates.

PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.


Commentaires cliniques (en anglais)

Family Medicine (FM)/General Practice (GP)

The relevance of this study is low because of the low use of these drugs for primary breast CA prevention. Additionally, the target group is very small; more effort spent on other modifiable risk factors (smoking, alcohol, exercise, obesity) can produce as much benefit without the significant side effects of (especially) tamoxifen and raloxifene.

Voulez-vous savoir ce que lisent les professionnels? Inscrivez-vous pour accéder gratuitement à tous les contenus professionnels.

S'inscrire