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Martin C. Mahoney

Qualitative and quantitative approaches to risk assessment are useful for identifying women at increased risk for developing breast cancer for whom genetics consultation, individualized surveillance recommendations, or chemoprevention may be appropriate. A comprehensive medical and family history review can be used to stratify women into categories of breast cancer risk. A quantitative estimate of the probability of developing breast cancer can be determined using risk assessment tools, such as the Gail and Claus models. Women at increased risk for breast cancer may benefit from individualized approaches to breast cancer risk reduction. Prevention strategies for reducing breast cancer risk include lifestyle modifications, chemoprevention, surgical approaches, and pharmacotherapy.

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Laura M. Kulik

hepatocellular carcinoma that developed after elimination of hepatitis C virus RNA by interferon therapy. A closed cohort study including matched control patients . Oncology 2003 ; 65 : 204 – 210 . 60. Kensler TW Egner PA Wang JB . Chemoprevention

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Therese B. Bevers

The 1998 approval of tamoxifen for breast cancer risk reduction opened the era of breast cancer chemoprevention. Women at increased risk for breast cancer now had an option other than healthy lifestyle and prophylactic surgery to reduce risk. However, women and their physicians were reluctant to use tamoxifen because of associated risks. Several trials investigating raloxifene suggested it may reduce breast cancer risk without having an apparent effect on the endometrium. The Study of Tamoxifen and Raloxifene (STAR) for the Prevention of Breast Cancer trial opened in 1999 to directly compare raloxifene to tamoxifen for breast cancer risk reduction. Since the unblinding of the STAR trial in 2006, raloxifene has emerged as an option for reducing breast cancer risk for postmenopausal women at increased risk for the disease.

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Therese B. Bevers, Deborah K. Armstrong, Banu Arun, Robert W. Carlson, Kenneth H. Cowan, Mary B. Daly, Irvin Fleming, Judy E. Garber, Mary Gemignani, William J. Gradishar, Helen Krontiras, Swati Kulkarni, Christine Laronga, Loretta Loftus, Deborah J. MacDonald, Martin C. Mahoney, Sofia D. Merajver, Ingrid Meszoely, Lisa Newman, Elizabeth Pritchard, Victoria Seewaldt, Rena V. Sellin, Charles L. Shapiro and John H. Ward

chemoprevention . J Natl Cancer Inst 2001 ; 93 : 358 – 366 . 26. Gail MH Costantino JP . Validating and improving models for projecting the absolute risk of breast cancer . J Natl Cancer Inst 2001 ; 93 : 334 – 335 . 27. Fisher B

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Arvind Bambhroliya, Mariana Chavez-MacGregor and Abenaa M. Brewster

://www.cancer.gov/bcrisktool ), or other validated models (including Tyrer-Cuzick), or by the eligibility criteria used in the various breast cancer chemoprevention trials. c NCI Breast Cancer Risk Assessment Tool ( https://www.cancer.gov/bcrisktool ). medications (B

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Patrick M. Lynch

. Limitations of the evidentiary base for extracolonic screening are conceded, with some cautious suggestions for possible strategies notwithstanding this lack of data. Advances in chemoprevention have been made in both familial adenomatous polyposis (FAP

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Mamta Mehta and Moshe Shike

. 42 Carroll C Cooper K Papaioannou D . Supplemental calcium in the chemoprevention of colorectal cancer: a systematic review and meta-analysis . Clinical Therapeutics 2010 ; 32 : 789 – 803 . 43 Grau MV Baron JA Sandler RS

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Reduction 09 2007 5 5 8 8 774 774 774 774 0050774 10.6004/jnccn.2007.0070 Breast Cancer Risk Reduction and Counseling: Lifestyle, Chemoprevention, and Surgery Mahoney Martin C. MD, PhD 09 2007 5 5 8 8 800 800 808 808 0050800 10.6004/jnccn

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Sofia D. Merajver and Kara Milliron

D Byrne C . Validation of the Gail et al. model of breast cancer risk prediction and implications for chemoprevention . J Natl Cancer Inst 2001 ; 93 : 358 – 366 . 15 Gail M Rimer B . Risk of risk-based mammography screening, age 40

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Kaylene Ready and Banu Arun

; chemoprevention in the form of tamoxifen, which may reduce breast cancer risk by up to 50% 4 , 5 ; prophylactic mastectomy, which reduces breast cancer risk by 90% to 95% 5 – 7 ; and prophylactic oophorectomy, which reduces breast cancer risk by 55% to 70% if