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Der Klinikarzt 2012; 41(3): 119-126
DOI: 10.1055/s-0032-1311509
Schwerpunkt
© Georg Thieme Verlag Stuttgart · New York

Primärprävention des Mammakarzinoms – State of the Art

Breast Cancer Prevention – State of the Art
Sabine Thor-Wiedemann
1   Medizinpresse, Weingarten
,
Günther J Wiedemann
2   Oberschwabenklinik, Ravensburg
› Author Affiliations
Further Information

Publication History

Publication Date:
26 March 2012 (online)

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Einige Faktoren, die das Brustkrebsrisiko erhöhen, wie Übergewicht, körperliche Inaktivität, hoher Alkoholkonsum, Diabetes oder Hormonersatztherapie, können durch Änderungen des Lebensstils günstig beeinflusst werden. Bei erhöhtem Risiko aufgrund nicht modifizierbarer Risikofaktoren, wie höheres Lebensalter, hereditäre Brustkrebsformen, Kinderlosigkeit, frühe Menarche oder späte Menopause, kann nach individueller Nutzen-Risiko-Abwägung eine medikamentöse (Tamoxifen, Raloxifen, Aromatasehemmer) oder chirurgische (bilaterale Mastektomie) Primärprävention in Betracht gezogen werden. Der Stellenwert anderer medikamentöser Interventionen, z. B. mit nicht-steroidalen Antirheumatika, Vitamin D oder Antidiabetika ist bisher noch nicht ausreichend geklärt. Da medikamentöse und chirurgische Primärprävention gleichbedeutend mit einer Therapie gesunder Frauen mit lediglich statistisch erhöhtem Risiko ist, kann eine entsprechende Entscheidung nur gemeinsam mit der betroffenen Frau nach sorgfältiger Nutzen-Risiko-Bewertung getroffen werden.

Some risk factors for breast cancer like obesity, sedentary lifestyle, diabetes, alcohol abuse or hormone replacement therapy are modifiable by lifestyle interventions. In women highly at risk with non modifiable risk factors, like age, hereditary risks, nulliparity, early onset of menarche or delayed menopause, the use of substances like tamoxifen, raloxifene or aromatase inhibitors may be considered after evaluation of the risks and benefits. In hereditary forms of breast cancer (like BRCA 1, 2 mutations) bilateral mastectomy reduces the risk considerably. The benefit of interventions like non steroidal anti inflammatory drugs, vitamin D or antidiabetics remains unclear. As preventive medication and surgery means treatment of healthy women at only statistically elevated risk, the decision must be discussed with the patient considering risks and benefits in a shared decision-making process.

Key words

breast cancer prevention - risk assessment - risk reduction - chemoprevention - lifestyle interventions
 

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