The role of the primary care physician in the prevention, diagnosis and treatment of breast cancer: contemporary knowledge and controversies.

摘要

Dr. Mary Hooks reminds us that we have achieved the primary prevention of breast cancer (BC) without seeming to have noticed it.1 The specific estrogen receptor modulators tamoxifen and raloxifene have both been shown to significantly reduce the risk of BC in pre- and postmeno-pausal American women; the latter without an increased risk of endometrial cancer. Yet few without a history of BC are receiving these agents. Patients and physicians have conflated tamoxifen with nonspecific cytotoxic drugs and have avoided it. But raloxifene is already used to retard osteoporosis. It is time for primary care physicians to prescribe it for women at increased risk, assuming the same responsibility for primary BC prevention as they already do for secondary prevention by mammographic screening.