Breast cancer chemoprevention – a vision not yet realized P. BLAHA, md, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, P. DUBSKY, md, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, F. FITZAL, md, professor, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, T. BACHLEITNER-HOFMANN, md, professor, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, R. JAKESZ, md, professor, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, M. GNANT, md, professor, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Vienna, & G. STEGER, md, professor, Department of Oncology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria BLAHA P., DUBSKY P., FITZAL F., BACHLEITNER-HOFMANN T., STEGER G., JAKESZ R. & GNANT M. (2009) European Journal of Cancer Care 18, 438–446 Breast cancer chemoprevention – a vision not yet realized Despite recent advances in the surgical and medical treatment of breast cancer, the number of patients dying from the disease is still high. In addition to improvements of early diagnosis and treatment, the overall mortality of breast cancer could be reduced by means of preventive intervention in both women with particularly normal and with high risk. Preventing the potentially deadly disease is presumably more effective than treatment, for life quality issues as well as for the economic perspective. Chemoprevention though is still a research field with results from large prevention trials being discussed controversially. For women with a defined increased risk for breast cancer, tamoxifen may be a choice for chemoprevention, balancing carefully benefits against risks. With promising results in adjuvant settings, aromatase inhibitors may deliver better prevention treatment options in the future, nevertheless, more research is needed to reliably predict risk on an individual basis in the future. Keywords: prevention, breast cancer, tamoxifen, anastrozole, aromatase inhibitors. INTRODUCTION In the past few decades, progresses in early detection and treatment of breast cancer have profoundly improved both disease-free (DFS) and overall survival. Nevertheless, breast cancer has the highest incidence of all cancers in women and remains one of the main causes of death. Several therapeutic interventions have become standard of care in the palliative, adjuvant and neoadjuvant setting and some of them – particularly endocrine interventions for hormone receptor-positive breast cancer – are suffi- ciently non-toxic for long-term administration. In the field of oncology, an alternative to treat estab- lished disease would be prevention of cancer develop- ment, thus disabling the threat of life as well as deterioration of quality of life by treatments or by the disease itself. In addition to the benefits of successful prevention for patients (who will then never become ‘patients’), a successful preventive intervention would bear the potential of avoiding the rapidly growing treatment cost for common malignancies like breast cancer. Already, the horrendous cost of established treat- ments precludes their general use in many parts of the world. Also, although we still are lacking complete under- standing of the molecular mechanisms of pathogenesis Correspondence address: Michael Gnant, Department of Surgery, Medical University of Vienna, Vienna General Hospital, Waehringer Guertel 18-20, A-1090 Vienna, Austria (e-mail: michael.gnant@meduniwien.ac.at). Accepted 24 March 2008 DOI: 10.1111/j.1365-2354.2008.00951.x European Journal of Cancer Care, 2009, 18, 438–446 Review article © 2009 The Authors Journal compilation © 2009 Blackwell Publishing Ltd