Endocrine therapy for breast cancer prevention in high-risk women: clinical and economic considerations

A literature search was performed using six relevant databases (MEDLINE, Embase, Database of Abstracts of Reviews of Effects, Health Technology Assessment Database, NHS Economic Evaluation Database, and SCOPUS) from January 2010 to July 2021. All economic studies were independently assessed by two reviewers using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist to evaluate the quality of the economic evaluations. To compare the different currencies used in these studies, all costs were converted to international dollars (2021).

Data availability statement

Given these findings, prescribers are advised to take into account individual patient’s understanding and concerns in order to support adherence and shared decision-making34,35. Our study supports this call for individualized assessment and clinical interactions in light of participants’ range of knowledge, expectations, and treatment-related beliefs and concerns. Adult patients aged 18 years or older who were prescribed an AI or tamoxifen for breast cancer at a public hospital managed by the Hospital Authority in Hong Kong from January 1, 1999, to December 31, 2020, were included in the study.

Potential biases in the review process

The aromatase gene is complex and highly regulated and exhibits tissue-specific expression in the ovaries/testes, breast tissue, adipose/skin, brain, placenta, and bone (Santen et al., 2009). As a result, AIs may have significant effects on these tissues, particularly on the bone and joints where the rates of bone loss are increased. Similarly, in the skin, AIs decrease the conversion of androgens to estrogens, which in turn increases the amount of androgen that can be converted into dihydrotestosterone and results in side effects such as androgenetic alopecia (Rossi et al., 2020). Additionally, estrogens have been shown to promote cell-proliferation in human tissue, thereby having the potential to lead to tumor formation. Estrogens also significantly affect humoral immunity and increase immunoglobulin levels (Aguilar-Pimentel et al., 2020; Cutolo et al., 2012). We identified 1,622 non-duplicate citations, of which 40 were recognized as potentially relevant and the full text articles retrieved.

• While synthetic aromatase inhibitors, which block the conversion of endogenous androgens to estrogenic compounds, have been evaluated in breast cancer patients, less is known about naturally occurring substances that may exert similar effects 23.
• To get the most benefit out of hormone therapy, you need the full recommended course of treatment.
• Although there is evidence of negative impact of the aromatase inhibitors on bone, our data still show a poor application of the recommendations in order to prevent osteoporosis related to the administration of these drugs.
• The app communicated the onset of adverse symptoms and AI adherence through built-in alerts sent to the patient’s care team.
• Red wine is not the same, and it may be that certain wines are more beneficial than others.

21, 22 This approach has been employed in other studies comparing CEAs across countries. 25 We also abstracted the survival benefit the models estimated for aromatase inhibitors compared to tamoxifen. For many years it was accepted that hormone replacement therapy with oestrogen could partly reverse the increase in cardiovascular risk occurring at menopause. However, the cardioprotective effects of exogenous oestrogen have now been called into question (Hulley et al, 1998; Women’s Health Initiative Steering Committee, 2004). Despite doubts surrounding the effects of oestrogen on cardiovascular risk, there remains concern that lowering oestrogen levels during adjuvant therapy for breast cancer might have detrimental effects on lipid levels and might also increase cardiovascular risk.

MHT is also called postmenopausal hormone use or hormone replacement therapy (HRT). When these hormones attach to special proteins called hormone receptors, the cancer cells with these receptors grow. No protocol was available for the included study; therefore, Steroids buy the risk of selective reporting was unclear. Regarding the allocation concealment, which was unspecified, we attempted to contact the authors to obtain additional details. Therefore, the sequence generation was assessed as ‘unclear’ for allocation concealment. The study Badawy 2012 was excluded because it targeted uterine adenomyosis, instead of uterine fibroids.