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Geburtshilfe Frauenheilkd 2006; 66(12): 1134-1142
DOI: 10.1055/s-2006-924599
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Georg Thieme Verlag KG Stuttgart · New York

Brustkrebsprävention in der klinischen Praxis - Möglichkeiten und Grenzen

Breast Cancer Prevention in Clinical Practice - Potential and LimitationsC. Tempfer1 , E. Bentz1
  • 1Universitätsklinik für Frauenheilkunde Wien, Klinische Abteilung für gynäkologische Endokrinologie und Sterilitätsbehandlung
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Publication History

Eingang Manuskript: 8.5.2006 Eingang revidiertes Manuskript: 19.8.2006

Akzeptiert: 28.8.2006

Publication Date:
22 December 2006 (online)

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Zusammenfassung

Brustkrebs ist jene bösartige Erkrankung, mit der der/die in der klinischen Praxis tätige Gynäkologe/in am häufigsten konfrontiert ist. Für folgende präventiv wirksame Interventionen liegen wissenschaftlich verwertbare Daten vor: diätetische Maßnahmen, sportliche Aktivität, Phytoöstrogene, Pharmakoprävention mittels selektiven Östrogenrezeptormodulatoren (SERMs), prophylaktische Chirurgie, sowie Aspirin und Nahrungsergänzungen/Vitamine. Eine bestimmte Diät zur Brustkrebsprävention kann nicht empfohlen werden. Weder eine fettarme noch eine vegetarische oder mediterrane Diät haben nachweislich einen positiven Einfluss auf das Brustkrebsrisiko. Eine fettreduzierte Diät ohne Gewichtsabnahme führt zu keiner Reduktion der Brustkrebsinzidenz. Auf der anderen Seite gibt es eine Reihe von indirekten Hinweisen aus epidemiologischen und tierexperimentellen Daten, dass eine simple aber dauerhafte Reduktion der Gesamtkalorienmenge von etwa 30 % verbunden mit einer BMI-Reduktion die Brustkrebsinzidenz, die Langzeitmorbidität und ‐mortalität reduziert und die Lebensdauer verlängert. Eine Brustkrebsprävention durch Sport ist nicht nachgewiesen, allerdings ist es aufgrund der Datenlage empfehlenswert, dass Frauen zur Brustkrebsprävention eine sportliche Betätigung ausüben, deren Ausmaß zwischen 3 und 5 Wochenstunden beträgt. Eine bestimmte Sportart kann nicht empfohlen werden. Eine Phytoöstrogensupplementierung zur Brustkrebsprävention kann nicht empfohlen werden. Es existiert kein gesicherter Hinweis darauf, dass eine peri- oder postmenopausale Phytoöstrogentherapie das Brustkrebsrisiko beeinflusst. Frauen mit einem erhöhten Brustkrebsrisiko kann eine prophylaktische Therapie mit Tamoxifen angeboten werden. Frauen mit einem unsubstituierten postmenopausalen Serumöstradiolspiegel > 10 pmol/L kann eine Chemoprävention mit Raloxifen angeboten werden. Durch den prophylaktischen Einsatz von Tamoxifen oder Raloxifen kann während der Einnahme die Inzidenz von hormonrezeptorpositiven Mammakarzinomen um 48 % reduziert werden. Eine chirurgische Prävention durch Salpingo-Oophorektomie ist neben Frauen mit hereditärer Brustkrebsbelastung durch BRCA-Mutation auch für Frauen mit einer Verwandten ersten Grades mit Ovarialkarzinom, Frauen nach sporadischem Mammakarzinom und Frauen mit hereditärem Kolonkarzinomsyndrom (HNPCC) empfehlenswert. Die fehlende Wirksamkeit einer brustkrebspräventiven Aspirin- und Vitamin-E-Einnahme wurde in prospektiv-randomisierten Studien nachgewiesen. Für andere Vitamine und Spurenelemente existieren keine prospektiv-randomisierten Daten, die epidemiologischen Studien sind inkonklusiv. Vitamine und Spurenelemente können daher zur Brustkrebsprävention nicht empfohlen werden.

Abstract

The validity of various strategies for breast cancer prevention has been investigated in scientific studies, including studies on dietary changes, physical activity, chemoprevention by selective estrogen receptor modulators (SERMs), prophylactic surgery, and the supplementation of phytoestrogens, aspirin, and vitamins. Epidemiologic and intervention studies were not able to demonstrate a favourable influence of low fat, vegetarian or Mediterranean diets on the risk of developing breast cancer. Experimental evidence, however, does appear to indicate that an increase in life-span, reduced mortality, and reduced cancer incidence occurs in individuals with sustained caloric restriction and body mass index (BMI) reduction. The preventive efficacy of physical activity has not been proven in intervention studies, but epidemiologic evidence consistently suggests that 3 to 5 hours of exercise per week reduces the risk of breast cancer. A supplementation with phytoestrogens has not been demonstrated to protect against breast cancer and cannot be recommended. Women with an elevated risk of breast cancer may use tamoxifen or raloxifen and can expect to reduce the risk of hormone receptor positive breast cancer during drug intake by 48 %. Prophylactic salpingo-oophorectomy (PSO) has been proven beneficial in women at risk for hereditary breast cancer and those with a first degree relative with ovarian cancer. In addition, breast cancer survivors and women at risk for hereditary non-polyposis colon cancer (HNPCC) benefit from PSO and prophylactic hysterectomy and PSO, respectively. Randomized controlled trials have shown that aspirin and vitamin supplementation do not offer protection against breast cancer and these compounds are therefore not recommended.

Schlüsselwörter

Brustkrebs - Prävention - Diät - Chemoprävention

Key words

Breast cancer - prevention - diet - chemoprevention

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C. Tempfer

Universitätsklinik für Frauenheilkunde Wien
Klinische Abteilung für gyn. Endokrinologie u. Sterilitätsbehandlung

Währinger Gürtel 18 - 20

1090 Wien

Österreich

Email: clemens.tempfer@meduniwien.ac.at