HORMONAL PREVENTION OF THE BREAST-CANCER - ARE WE HEADING IN THE RIGHT DIRECTION

A great deal of progress has been made in the last twenty years in und erstanding the hormone-dependence of cancer of the breast and the mech anism of action of estrogens and antiestrogens at the level of normal and cancerous mammary cells. The effect of estrogens in promoting mamm ary epithelial cell proliferation, the antiestrogenic effect of tamoxi fen (TAM) on the breast, whilst maintaining a substantial estrogenic e ffect on the bone and some lipid parameters, and the characterization of populations at risk are the determining elements on which two studi es recently set up in Great Britain and the United States were based. The aim of these studies is to determine the long-term effects of TAM in the prevention of cancer of the breast. The choice of population in both cases focused on women presenting known risk factors. We discuss in this review the hormonal basis for a breast cancer prevention and its different possibilities. We point out the different aspects which lead us to conclude that the current fad for multicentric use of tamox ifen throughout the world within the scope of primary prevention, of c ancer of the breast is not only unjustified but may be also dangerous. However, such a discussion is very important when one considers that cancer of the breast is the most frequent form of cancer in women (aff ecting one woman in 8) and that overall mortality from this type of ca ncer has not changed in the last thirty years.