Chemoprevention Agents to Reduce Mammographic Breast Density in Premenopausal Women: A Systematic Review of Clinical Trials
A partir d'une revue systématique de la littérature publiée jusqu'en janvier 2020 (6 essais cliniques), cette étude analyse l'effet de traitements hormonaux réduisant la densité mamaire pour prévenir le risque de cancer du sein chez les femmes avant la ménopause
Résumé en anglais
Higher mammographic breast density (MBD) is associated with higher breast cancer risk when compared to lower MBD in premenopausal women. However, little is known about the effectiveness of chemoprevention agents in reducing MBD in premenopausal women without a history of breast cancer. Findings from this review should provide insight on how to target MBD in breast cancer prevention in premenopausal women with dense breasts.We searched nine electronic databases for clinical trials in English, Spanish, French, or German published until January 2020. Articles evaluating the association of pharmacological agents and MBD were included. Data was extracted on methods, type/dose of intervention, outcomes, side effects, and follow-up. Quality of the studies was assessed using the U.S. Preventive Services Task Force criteria.We identified 7 clinical trials evaluating the associations of 6 chemoprevention agents with changes in MBD in premenopausal women without history of breast cancer. The studies evaluated selective estrogen-receptor modulators (n = 1), gonadotropin release hormone agonists (GnRHAs) (n = 2), isoflavones (n = 1), Vitamin D (n = 1), and Boswellia, betaine and mayo-inositol compound (n = 1). Hormonal interventions were associated with net reductions in percent density: tamoxifen (13.4%), leuprolide acetate (8.9%) and goserelin (2.7%) while non-hormonal (vitamin D and isoflavone) interventions were not. However, MBD returned to pre-intervention baseline-levels after cessation of GnRHAs.A limited number of chemoprevention agents have been shown to reduce MBD in premenopausal women. Identification of new and well-tolerated chemoprevention agents targeting MBD, as well as larger studies to confirm agents that have been studied in small trials are urgent priorities for primary breast cancer prevention in premenopausal women with dense breasts.
