Breast Cancer Prevention.pptx

8/18/2019 Breast Cancer Prevention.pptx

1/89

Breast CancerPrevention

Jose Pacheco MD


2/89


3/89

Goss et al.

• Randomized, placebo-controlled, double-blind trial

•

Population -> post-menopausal omen, at least !" #ears o$ a%e or older ithe $olloin%& '%e () #ears or older, Gail " #ear ris* score %reater than +.((ductal or lobular h#perplasia or lobular carcinoma in situ, or DC ith mast

• / 0 1"()

• Group +• 23emestane

• 'nnual incidence o$ invasive breast cancer -> ).+4, 5R ).!", p 0 ).))6

• 'nnual incidence o$ invasive 7 non-invasive breast cancers -> ).!", 5R ).18, p 0 )

• 'dverse events 9 ::, p 0 ).))!

• Group 6• Placebo

• 'nnual incidence o$ invasive breast cancer -> ).""

• 'nnual incidence o$ invasive 7 non-invasive breast cancers -> ).88

• 'dverse events 9 :"

•

Median $ollo-up as !" months


4/89


5/89


6/89


7/89


8/89


9/89


10/89


11/89

';'C %roup

• Median $ollo-up period 18 months

• 2ndpoints -> D aduvant treatment o$ post-menopausal omen ith earl# sta%e b

• Group +• 'nastrozole

• =ess $re?uent -> endometrial cancer, va%inal bleedin% or dischar%e, cerebrovascular eventhromboembolic events, hot @ashes

• More $re?uent -> musculos*eletal disorders and $ractures

• 1 #ear D 5R ).:6, p 0 ).)+1

• 1 #ear ;;R 9 5R ).:!, p 0 ).)+"

• BeneAt %reater $or those ith 5R positive tumors -> 5R ).8:, p 0 ).))8

• 1 #ear C=BC recurrence -> 5R ).(6, p 0 ).)(6

• BeneAt %reater $or those ith 5R positive tumors -> 5R )."(, p 0).)16

• Group 6• ;amo3i$en

• 1 #ear D


12/89


13/89


14/89


15/89


16/89

Cuzic* et al.

• Population -> 8+1" omen a%es !" to 8) and at increasebreast cancer

• Group +, n 0 !"84• ;amo3i$en 6) m%d $or " #ears

• Ris* o$ invasive breast cancer 9 5R ).8!, p 0 ).))1• /o dierence $or 2R ne%ative tumors 9 5R +.))

• i%niAcant dierence $or 2R positive tumors 9 5R ).((

• RR $or pulmonar# embolismD; durin% active treatment 9 6.6(• RR $or pulmonar# embolismD; a$ter tamo3i$en stopped 9 +.+

• Group 6, n 0 !"8"• Placebo $or " #ears

• Primar# outcome -> incidence o$ breast cancer, includin%

• Median $ollo-up 4( months


17/89


18/89


19/89


20/89


21/89


22/89


23/89


24/89


25/89


26/89


27/89


28/89


29/89

+!,!:: omen ere randoml# assi%nereceive placebo or tamo3i$en $or " #ears

• Group +• ;amo3i$en

• Rate o$ invasive breast cancer 9 5R )."8

•

Rate o$ non-invasive breast cancer 9 5R ).(!• Rate o$ osteoporotic $ractures 9 5R ).(:

• Group 6• Placebo


30/89


31/89


32/89


33/89


34/89


35/89


36/89


37/89


38/89


39/89


40/89


41/89


42/89


43/89


44/89


45/89


46/89

+!,!:: omen ho ere at increased ris* $or breast

• () #ears o$ a%e or older

• !"-") #ears o$ a%e ith a " #ear predicted ris* o$ at least +.((

• 5istor# o$ lobular carcinoma in situ

• Group +, n 0 ((:+• ;amo3i$en 6) m%d $or " #ears

• Ris* o$ invasive breast cancer -> 5R )."+, p E ).))))+

• Ris* o$ non-invasive breast cancer -> 5R )."), p E ).))6

• Ris* o$ 2R positive tumors -> 5R ).!+

• Reduced the rate o$ hip $ractures• Ris* o$ endometrial cancer as increased 9 5R 6."! Fthis as mainl# in th

a%e and older, all ere sta%e +

• tro*e, D; and P2 ere increased Fmainl# in ") #ears o$ a%e and up

• Group 6, n 0 (8)(• Placebo

•Median $ollo-up as "" months


47/89


48/89


49/89


50/89


51/89


52/89


53/89


54/89


55/89


56/89


57/89


58/89


59/89


60/89


61/89


62/89

o%el et al


63/89

o%el et al.

• :+ month median $ollo-up

• Group +• ;amo3i$en 6) m%d $or " #ears

• Group 6• Ralo3iAne () m%d $or " #ears

• Ris* $or invasive breast cancer, 5R +.61 Fsi%niAcant

• Ris* $or non-invasive breast cancer, 5R +.66 Fnot ?uite si%

• Ris* $or endometrial cancer, 5R )."", p 0 ).))!

• Ris* $or uterine h#perplasia, 5R ).+4, si%niAcant

• Ris* $or thromboembolic events, 5R ).8", si%niAcant


64/89


65/89


66/89


67/89


68/89


69/89


70/89


71/89


72/89


73/89


74/89

5artmann et al.


75/89

• Retrospective stud#

• Population -> omen ith a $amil# histor# o$ breastho underent proph#lactic mastectom#

• (!4 omen F6+1 at hi%h ris* and 16" at moderate ris*

• 5R $or breast cancer in moderate ris* %roup -> 5R ).+), p

• 5R $or breast cancer in the hi%h ris* %roup -> 5R ).+)

• Control -> sisters o$ hi%h ris* probands ho did not proph#lactic mastectom# and Gail model in the patipopulation

• Median len%th o$ $ollo-up as +1 #ears


76/89


77/89


78/89


79/89


80/89


81/89


82/89

Domchec* et al.


83/89

• Prospective, multi-center, cohort stud#

• Population -> 61:6 omen ho tested positive $or BRC'+ or BRC'6

• Ris* reducin% mastectom#• / 0 6"8• /o breast cancers dia%nosed in this population Fcompared to 8 ithout

• Ris* reducin% salpin%-oopherectom#• / 0 44!

• +.+ dia%nosed ith ovarian cancer F".: ithout• n those ith a histor# o$ breast cancer, 5R ).!+

• n those ithout a histor# o$ breast cancer, 5R ).+"

• =oer ris* o$ Arst breast cancer in BRC'+ mutation carriers, 5R ).(!

• =oer ris* o$ Arst breast cancer in BRC'6 mutation carriers, 5R ).!(

• 'll cause mortalit#, 5R ).1)

• Breast cancer speciAc mortalit#, 5R ).11

• Hvarian cancer speciAc mortalit#, 5R ).6"

• ++.1 ith breast cancer F+4.6 ithout

• !.1 died $rom an# cause F+) ithout

• Hutcomes -> breast and ovarian cancer ris*, cancer speciAc and overall mor

Domchec* et al.


84/89


85/89


86/89


87/89


88/89


89/89

Documents

Breast Cancer Prevention.pptx