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N

azário

ACP

et

al

.

552

R

ev

A

ssoc

M

ed

B

ras

2015; 61(6):543-552

After menopause, estrogen production occurs at the ex-

pense of the peripheral conversion of androgens to estro-

gens mediated by aromatase, which is abundant in fatty tis-

sue. Thus, aromatase inhibitors present a more rational

fundament, because they prevent the production of estro-

gen, while tamoxifen blocks estrogen, which has already

been produced. Inhibitors may bind irreversibly (exemes-

tane) or reversible (anastrozole and letrozole) to aromatase,

and can be given in three manners: (a) sequentially for five

years after the usual five years of tamoxifen therapy; (b) se-

quentially after two to three years of tamoxifen and, in this

case, aromatase inhibitors are continued until the comple-

tion of five years of endocrine therapy; (c) single isolated

form, for five years. The best scheme, which results in lon-

ger survival, has not yet been defined. The main side effects

are hot flushes, arthralgia, myalgia and the negative effect

on bone mass, increasing the risk of osteoporosis. Anastro-

zole, letrozole and exemestane are prescribed orally at dos-

es of 1 mg, 2.5 mg and 25 mg, respectively.

Fulvestrant is an estrogen receptor antagonist, pro-

ducing degradation and blocking transcription. It is free

of agonist effects after binding to the receptor and it is

used at a dose of 500 mg, once a month, intramuscular-

ly. The drug is indicated for cases of relapse after treat-

ment with tamoxifen or aromatase inhibitors.

R

esumo

Câncer demama: novidades no diagnóstico e no tratamento

Os autores discutem as principais novidades no diagnósti-

co e no tratamento do câncer de mama, particularmente

no diagnóstico por imagem, no rastreamento e nas tera-

pêuticas locorregional e sistêmica.

Palavras-chave:

câncer de mama, diagnóstico, tratamento.

R

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