Serum hormone concentrations and individualisation of breast cancer prevention

Breast cancer poses significant challenges in public health and has a considerable impact globally, with approximately 2·3 million new cases and 685 000 deaths worldwide each year. 1 WHOBreast cancer. https://www.who.int/news-room/fact-sheets/detail/breast-cancerDate: 2023 Date accessed: July 12, 2023 Google Scholar Several efforts revolve not only around improving treatment outcomes but also in preventing the development of this disease. Multiple clinical trials have evaluated endocrine therapies for breast cancer prevention. In a 2019 updated meta-analysis of more than 5 million participants for the US Preventive Services Task Force, 2 Nelson HD Fu R Zakher B Pappas M McDonagh M Medication use for the risk reduction of primary breast cancer in women: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2019; 322: 868-886 Crossref PubMed Scopus (61) Google Scholar the relative risk reduction with tamoxifen was 0·69 (95% CI 0·59–0·84), with raloxifene was 0·44 (0·24–0·80), and with aromatase inhibitors was 0·45 (0·26–0·70). Across 25 of the 46 studies included in the meta-analysis, the performance of 18 risk-assessment models used to select patients was also evaluated. Disappointingly, these studies showed the low accuracy of these models in predicting the incidence of breast cancer, with an area under the curve ranging from 0·55 to 0·65. These results signify the importance of developing better risk-prediction models or biomarkers to select patients more likely to benefit from these preventive measures. Effect of baseline oestradiol serum concentration on the efficacy of anastrozole for preventing breast cancer in postmenopausal women at high risk: a case-control study of the IBIS-II prevention trialThese results suggest that serum hormones should be measured more routinely and integrated into risk management decisions. Measuring serum hormone concentrations is inexpensive and might help clinicians differentiate which women will benefit most from an aromatase inhibitor. Full-Text PDF Open Access