Types/breast/breast-hormone-therapy-fact-sheet

Daaweynta Hormone ee Kansarka Naasaha

Waa maxay hormoonnada?

Hormoonnada waa walxo u shaqeeya sida farriimaha kiimikada ee jirka ku jira. Waxay saameyn ku yeeshaan ficillada unugyada iyo unugyada meelo kala duwan oo jirka ku yaal, iyagoo inta badan ku gaara bartilmaameedyadooda marinka dhiigga.

Hormoonnada estrogen iyo progesterone waxaa sameeya ugxan sidaha dumarka premenopausal iyo unugyo kale oo qaarkood, oo ay ku jiraan baruur iyo maqaar, labadaba dhalmada ka hor iyo dhalmada kadib. Estrogen-ku wuxuu kobciyaa horumarinta iyo dayactirka astaamaha galmada dumarka iyo koritaanka lafaha dhaadheer. Progesterone wuxuu door ka ciyaaraa wareegga caadada iyo uurka.

Estrogen iyo progesterone sidoo kale waxay kor u qaadaan koritaanka kansarka naasaha qaarkood, kuwaas oo loo yaqaan kansarka naasaha ee xasaasiga u ah hormoonka (ama hormoon ku tiirsan). Unugyada kansarka naasaha ee xasaasiga ah waxay ku jiraan borotiinno loo yaqaanno soo-dhoweeyaasha hoormoonka oo firfircoon marka hoormoonnada iyaga ku xidhaan. Rakkoolayaasha firfircoon waxay sababaan isbeddello ku saabsan muujinta hiddo-wadayaal gaar ah, oo kicin kara koritaanka unugyada.

Waa maxay daaweynta hoormoonka?

Daaweynta hormoonka (oo sidoo kale loo yaqaanno hormoonka daaweynta, daaweynta hoormoonka, ama daaweynta endocrine) waxay gaabisaa ama joojisaa koritaanka burooyinka xasaasiga ah ee hormoonnada iyadoo la xakameynayo awoodda jirka ee soo saarista hormoonnada ama faragelinta saamaynta hoormoonnada ee unugyada kansarka naasaha. Burooyinka aan xasaasiyadda lahayn hormoonku ma laha soo dhoweeyeyaasha hoormoonka mana ka jawaabaan daaweynta hoormoonka.

Si loo go'aamiyo in unugyada kansarka naasaha ay kujiraan qabtayaasha hoormoonka, dhakhaatiirtu waxay baaraan shaybaarka unugyada burooyinka ee qalliin looga soo saaray. Haddii unugyada burooyinka ay kujiraan qabtayaasha estrogen, kansarka waxaa loo yaqaan estrogen receptor positive (ER positive), estrogen sensitive, ama estrogen ka jawaab celiya. Sidoo kale, haddii unugyada burooyinka ay kujiraan qabtayaasha qanjirka 'progesterone receptors', kansarka waxaa loo yaqaan 'progesterone receptor positive' (PR ama PgR positive). Qiyaastii 80% kansarka naasaha waa ER (1). Inta badan kansarka naasaha ee ku dhaca ER-positive sidoo kale waa kuwo qaba PR. Burooyinka naasaha ee ay kujiraan estrogen iyo / ama qanjirka 'progesterone receptors' ayaa mararka qaarkood loo yaqaan 'receptor receptor positive' (HR positive).

Kansarka naasaha ee aan lahayn qabtayaasha estrogen waxaa loo yaqaan estrogen receptor negative (ER negative). Burooyinkaan waa estrogen dareen la'aan, taasoo la micno ah inaysan isticmaalin estrogen si ay u koraan. Burooyinka naasaha ee aan lahayn qabtayaasha qanjidhada 'progesterone receptors' waxaa loo yaqaan 'progesterone receptor negative (PR ama PgR negative). Burooyinka naasaha ee aan lahayn labadaba estrogen iyo progesterone reseptors ayaa mararka qaarkood loo yaqaan 'receptor receptor negative (HR negative).

Daaweynta hormoonka ee kansarka naasaha waa inaan lagu khaldin daaweynta hoormoonka menopausal (MHT) - daaweynta estrogen keligeed ama lagu daro progesterone si looga caawiyo yareynta calaamadaha menopause. Labadan nooc ee daaweynta waxay soo saaraan saameyn lid ku ah: daaweynta hoormoonka kansarka naasaha ayaa xannibaya koritaanka kansarka naasaha ee HR-positive, halka MHT ay kicin karto koritaanka kansarka naasaha ee HR-positive. Sababtaas awgeed, marka haweeneyda qaadata MHT laga helo kansarka naasaha ee HR-positive waxaa badanaa laga codsadaa inay joojiso daaweyntaas.

Waa maxay noocyada daaweynta hoormoonka loo isticmaalo kansarka naasaha?

Xeelado dhowr ah ayaa loo isticmaalaa in lagu daaweeyo kansarka naasaha ee hormoonka u nugul:

Joojinta shaqada ugxan sidaha: Sababtoo ah ugxansidaha ayaa ah isha ugu weyn ee estrogen ee haweenka premenopausal, heerarka estrogen ee haweenkan waa la yareyn karaa iyadoo laga takhaluso ama la xakameeyo shaqada ugxan sidaha. Joojinta shaqada ugxansidaha waxaa loo yaqaan ka-goynta ugxan sidaha.

Ka-soo-goynta ugxan-yaraha waxaa lagu sameyn karaa qalliin qalliin looga saarayo ugxan-sideyaasha (oo loo yaqaanno oophorectomy) ama iyadoo lagu daaweynayo shucaac. Noocan ka-goynta ugxansiduhu waa mid joogto ah.

Haddii kale, shaqada ugxan-sidaha ayaa si ku-meel-gaar ah loo xakamayn karaa iyada oo lagu daaweeyo daawooyinka loo yaqaan 'gonadotropin-releasing hormone' (GnRH) agonists, oo sidoo kale loo yaqaan 'luteinizing hormone-release hormone (LH-RH) agonists. Daawooyinkani waxay farageliyaan calaamadaha ka imanaya qanjirka 'pituitary gland' ee kiciya ugxan sidaha si ay u soo saaraan estrogen.

Tusaalooyinka dawooyinka xakamaynta ugxansidaha ee ay ansixisay Maamulka Cuntada iyo Dawooyinka ee Maraykanka (FDA) waa goserelin (Zoladex®) iyo leuprolide (Lupron®).

Joojinta wax soo saarka estrogen: Daawooyinka loo yaqaan aromatase inhibitors ayaa loo isticmaalaa in lagu xakameeyo waxqabadka enzyme loo yaqaan aromatase, kaas oo jidhku u isticmaalo sameynta estrogen ee ugxan sidaha iyo unugyada kale. Kahortagayaasha Aromatase waxaa loo adeegsadaa ugu horreyn dumarka postmenopausal maxaa yeelay ugxansidaha haweenka premenopausal waxay soo saaraan aromatase aad u badan oo loogu talagalay ka-hortaggayaasha inay si wax ku ool ah u xannibaan. Si kastaba ha noqotee, daawooyinkan waxaa loo isticmaali karaa haweenka premenopausal haddii la siiyo iyaga iyo daawada xakameysa shaqada ugxan sidaha.

Tusaalooyinka kahortaga aromatase ee ay ansixisay FDA waa anastrozole (Arimidex®) iyo letrozole (Femara®), oo labaduba si ku meelgaar ah u shaqeynaya aromatase, iyo tusaale ahaan (Aromasin®), oo si joogto ah u shaqeynaya aromatase.

Joojinta saameynta estrogen: Noocyo dhowr ah oo daroogo ah ayaa farageliya awoodda estrogen ee kicinta koritaanka unugyada kansarka naasaha:

• Isbeddeladayaasha qaabeeyaha estrogen-ka ee xaddidan (SERMs) waxay ku xiran yihiin qabtayaasha estrogen, ka hortagga estrogen in ay ku xirnaato. Tusaalooyinka SERMyada ay ansixisay FDA ee daaweynta kansarka naasaha waa tamoxifen (Nolvadex®) iyo toremifene (Fareston®). Tamoxifen waxaa loo isticmaali jiray in ka badan 30 sano in lagu daaweeyo kansarka naasaha ee hormoonka maqaarka leh.

Sababtoo ah SERMs waxay kuxiran yihiin qaboojiyeyaasha estrogen, waxay awood u yeelan karaan oo keliya inay xakameeyaan dhaqdhaqaaqa estrogen (ie, waxay u adeegaan sida estrogen antagonists) laakiin sidoo kale waxay la mid yihiin saamaynta estrogen (ie, waxay u adeegaan sida estrogen agonists). SERMyadu waxay u dhaqmi karaan sida estrogen antagonist-yada unugyada qaarkood iyo sida agonistayaasha estrogen ee unugyada kale. Tusaale ahaan, tamoxifen wuxuu xannibayaa saameynta estrogen ee unugyada naaska laakiin wuxuu u dhaqmaa sida estrogen ee ilmo-galeenka iyo lafta.

• Daawooyinka kale ee antiestrogen, sida fulvestrant (Faslodex®), waxay u shaqeeyaan si xoogaa ka duwan sidii loo xakameyn lahaa saameynta estrogen. Sida SERM-yada, fulvestrant waxay ku xidhan tahay soo-qabtaha estrogen waxayna u shaqaysaa sidii antagonist estrogen ah. Si kastaba ha noqotee, si ka duwan SERMs, fulvestrant wax saameyn ah kuma yeelato estrogen agonist. Waa antiestrogen saafi ah. Intaas waxaa sii dheer, marka fulvestrant uu ku xirmo qabtaha estrogen-ka, qaataha waxaa lala beegsadaa burbur.

Sidee loo daaweeyaa hormoonka daaweynta kansarka naasaha?

Waxaa jira saddex dariiqo oo waaweyn oo daaweynta hoormoonka loogu isticmaalo in lagu daaweeyo kansarka naasaha ee hormoonka u nugul:

Daaweynta ku-habboon ee kansarka naasaha ee marxaladda hore: Cilmi-baaris ayaa muujisay in haweenka qaata ugu yaraan 5 sano ee daaweynta ku-habboon ee loo yaqaan 'tamoxifen' ka dib qalliinka loogu talagalay kansarka naasaha ee heerka-hore ee ER-positive ay yareeyeen halista kansarka naasaha ee soo noqnoqda, oo ay ku jiraan kansarka naasaha cusub naaska kale, iyo dhimashada 15 sano (2).

Tamoxifen waxaa ansixisay FDA si loogu daaweeyo hormoonka loo yaqaan 'prejuopausal' iyo 'postmenopausal' (iyo ragga) oo qaba kansarka naasaha ee marxaladda hore, iyo aromatase inhibitors anastrozole iyo letrozole ayaa loo oggolaaday isticmaalkan dumarka postmenopausal.

Seddexaad aromatase inhibitor, exemestane, ayaa loo oggol yahay daaweynta ku-meel-gaarka ah ee kansarka naasaha-marxaladda hore ee haweenka postmenopausal ee horay u helay tamoxifen.

Ilaa dhowaan, dumarka badankood ee qaatay daaweynta hoormoonka loo yaqaan 'adjuvant therapy' si loo yareeyo fursadda kansarka naasaha ku soo noqnoqday waxay qaateen tamoxifen maalin kasta muddo 5 sano ah. Si kastaba ha noqotee, markii la hirgaliyay daaweynta hoormoonka cusub, qaar ka mid ah kuwaas oo la barbardhigay tamoxifen ee tijaabooyinka kiliinikada, habab dheeraad ah oo ku saabsan daaweynta hoormoonka ayaa noqday mid caadi ah (3-5). Tusaale ahaan, haweenka qaarkood waxay qaadan karaan aromatase inhibitor maalin kasta 5 sano, halkii laga qaadan lahaa tamoxifen. Haweenka kale waxaa laga yaabaa inay daaweyn dheeraad ah ku helaan aromatase inhibitor ka dib 5 sano oo tamoxifen ah. Ugu dambeyntiina, haweenka qaarkood waxaa laga yaabaa inay u beddelaan aromatase inhibitor ka dib 2 ama 3 sano oo tamoxifen ah, wadar ahaan 5 ama in ka badan sannado ah daaweynta hoormoonka. Cilmi baaris ayaa muujisay in dumarka dhalmo-dayska kadib ee laga daweeyay kansarka naasaha heerkiisa hore,

Go'aannada ku saabsan nooca iyo muddada daaweynta hormoonka ee loo yaqaan 'adjuvant therapy' waa in loo qaataa si shaqsi ahaaneed. Nidaamkan go'aan qaadashada ee murugsan waxaa sida ugu wanaagsan lagu fulin karaa iyadoo lala hadlayo dhakhtarka kansarka, oo ah dhakhtar ku takhasusay daaweynta kansarka.

Daaweynta kansarka naasaha ee horumarsan ama metastatic: Noocyo dhowr ah oo daaweynta hoormoonka ah ayaa loo oggolaaday in lagu daaweeyo kansarka naasaha ee metastatic ama soo noqnoqda. Daaweynta hoormoonka sidoo kale waa ikhtiyaar daaweyn ah oo loogu talagalay kansarka naasaha ee ER-positive oo ku soo laabtay naaska, gidaarka laabta, ama qanjidhada u dhow ee daaweynta ka dib (oo sidoo kale loo yaqaan 'soo noqnoqodka deegaanka').

Laba SERM ayaa loo oggolaaday inay daweeyaan kansarka naasaha ee metastatic, tamoxifen iyo toremifene. Qanjiraha 'antiestrogen fulvestrant' waxaa loo oggolaaday dumarka postmenopausal ee qaba kansarka naasaha ee metastatic ER-positive oo ku faafay ka dib markii lagu daaweeyay antiestrogens kale (7). Waxaa sidoo kale loo isticmaali karaa dumarka uurka ku jira ee uurka ka soo go'ay.

The aromatase inhibitors anastrozole iyo letrozole ayaa loo ogolaaday in la siiyo haweenka postmenopausal sidii daaweyn bilow ah oo loogu talagalay kansarka naasaha ee metastatic ama horumarsan ee maxaliga ah (8, 9). Labadan daroogo, iyo sidoo kale aromatase inhibitor exemestane, ayaa loo isticmaalaa in lagu daaweeyo haweenka postmenopausal ee qaba kansarka naasaha ee horumarsan oo cudurkoodu ka sii daray ka dib daaweynta tamoxifen (10).

Haweenka qaarkood ee qaba kansarka naasaha ee horumarsan waxaa lagu daaweeyaa isku-darka daaweynta hoormoonka iyo daaweynta la bartilmaameedsaday. Tusaale ahaan, daawada la beegsanayo ee dawada laatiinatiib (Tykerb®) ayaa la oggol yahay in loo isticmaalo isku darka loo yaqaan 'letrozole' si loogu daaweeyo hormoonka soo-dhoweynta hoormoonka ah, HER2-kansarka naasaha metastatic ee haweenka postmenopausal ee daaweynta hoormoonka loo muujiyey.

Daaweyn kale oo la bartilmaameedsaday, palbociclib (Ibrance®), ayaa la siiyay oggolaansho degdeg ah oo loogu talagalay isticmaalka isku darka 'letrozole' oo ah daaweyn bilow ah oo loogu talagalay daaweynta hoormoonka soo-dhoweynta-kansarka, HER2-kansarka naasaha ee horumarsan ee haweenka postmenopausal. Palbociclib wuxuu xannibayaa laba kinase oo ku tiirsan cyclin (CDK4 iyo CDK6) oo umuuqda inay kor uqaadayaan koritaanka hormoonka unugyada kansarka naasaha.

Palbociclib sidoo kale waa la ogolaaday in loo isticmaalo iyadoo lagu darayo fulvestrant si loogu daaweeyo haweenka qaba hormoonka soo dhaweynta hormoonka ah, HER2-kansarka horumarsan ama kansarka naasaha ee kansarkiisa uu kasii daray ka dib markii lagu daaweeyay hormoon kale.

Daaweynta neoadjuvant ee kansarka naasaha: Isticmaalka daaweynta hoormoonka ee lagu daaweeyo kansarka naasaha qalliinka ka hor (neoadjuvant therapy) ayaa lagu bartay tijaabooyinka bukaan socodka (11). Ujeedada daaweynta neoadjuvant waa in la yareeyo cabirka buro naasaha si loogu oggolaado qalliinka naas-nuujinta. Xogta laga helay tijaabooyinka la kala soocay ee la kala soocay ayaa muujisay in daaweynta hormoonka neoadjuvant-gaar ahaan, oo leh aromatase inhibitors -ku ay waxtar u yeelan karto yareynta cabirka burooyinka naasaha ee dumarka postmenopausal. Natiijooyinka haweenka uurka ku jira waa kuwo aan caddeyn sababta oo ah dhowr tijaabo oo yar yar oo ku lug leh haween aad u yar oo premenopausal ah ayaa la qabtay illaa iyo hadda.

Ma jiro daweyn hormoon ah oo wali ay ansaxisay FDA daaweynta neoadjuvant ee kansarka naasaha.

Daaweynta hoormoonka ma loo isticmaali karaa in looga hortago kansarka naasaha?

Haa. Inta badan kansarka naasuhu waa cillad ER ah, tijaabooyinka caafimaadna waxaa lagu tijaabiyay in daaweynta hoormoonka loo adeegsan karo kahortagga kansarka naasaha dumarka halista ugu jira inuu ku dhaco cudurka.

Maxkamad weyn oo NCI ah oo ay maalgelisay tijaabinta bukaan-socodka ee loo yaqaan 'Ka Hortagga Kansarka Naasaha' ayaa lagu ogaaday in tamoxifen, oo la qaatay muddo 5 sano ah, uu yareeyay halista ah inuu ku dhaco kansarka naasaha ee ku dhaca qiyaastii 50% haweenka postmenopausal ee khatarta sii kordhaya (12). Dabagalka muddada-dheer ee tijaabo kale oo la kala soocay, Daraasadda Caalamiga ah ee Ka Hortagga Kansarka Naasaha, waxaan ogaaday in 5 sano oo daaweynta tamoxifen ah ay yareyneyso dhacdooyinka kansarka naasaha ugu yaraan 20 sano (13). Maxkamad weyn oo la kala soocay, Daraasadda Tamoxifen iyo Raloxifene, oo sidoo kale ay maalgelisay NCI, ayaa lagu ogaaday in 5 sano ee raloxifene (SERM) ay yareyneyso halista kansarka naasaha ee haweenka noocaas ah qiyaastii 38% (14).

Natiijooyinka tijaabooyinkan awgood, tamoxifen iyo raloxifene labadaba waxaa ogolaaday FDA si loo yareeyo halista ah inuu ku dhaco kansarka naasaha haweenka halista sare ugu jira cudurka. Tamoxifen waa loo oggol yahay adeegsigan iyada oo aan loo eegin xaaladda menopausal. Raloxifene waxaa loo oggol yahay in loo isticmaalo oo keliya dumarka dhalmada ka dib.

Laba joojiye aromatase - tusaale ahaan iyo anastrazole — ayaa sidoo kale la ogaaday inay yareynayaan halista kansarka naasaha ee dumarka ka dambeeya dhalmada ka dib khatarta sii kordheysa ee cudurka. Ka dib 3 sano oo dabagal ah oo tijaabo ah oo la kala soocay, haweenka qaatay tusaale ahaan waxay ahaayeen 65% ka yar tahay kuwa qaatay placebo si ay u yeeshaan kansarka naasaha (15). Ka dib 7 sano oo dabagal ah tijaabo kale oo la kala soocay, haweenka qaatay anastrozole waxay 50% ka yar yihiin kuwa ku qaatay placebo inay yeeshaan kansarka naasaha (16). Labada tusaale iyo anastrozole labadaba waxaa ansaxiyay FDA si loogu daaweeyo haweenka qaba kansarka naasaha ee ER-positive. In kasta oo labadaba sidoo kale loo adeegsado kahortagga kansarka naasaha, midkoodna looma oggola tilmaantaas si gaar ah.

Waa maxay dhibaatooyinka soo raaca ee daaweynta hoormoonka?

Dhibaatooyinka soo raaca ee daaweynta hoormoonka waxay inta badan ku xiran tahay daroogada gaarka ah ama nooca daaweynta (5). Faa'iidooyinka iyo waxyeelada qaadashada daaweynta hoormoonka waa in si taxaddar leh loogu miisaamaa haweeney kasta. Istaraatiijiyad beddelaad guud ah oo loo adeegsado daaweynta xayeysiinta, taas oo bukaanku ku qaataan tamoxifen muddo 2 ama 3 sano ah, oo ay ku xigto aromatase inhibitor ah 2 ama 3 sano, ayaa laga yaabaa inay bixiso dheelitirka ugu fiican ee faa'iidooyinka iyo waxyeelada labadan nooc ee daaweynta hoormoonka (17) .

Nalalka kulul, dhididka habeenkii, iyo qalajinta xubinta taranka haweenka ayaa ah dhibaatooyinka guud ee daaweynta hormoonka. Daaweynta hormoonka ayaa sidoo kale carqaladeysa wareegga caadada ee haweenka premenopausal.

Dhibaatooyinka aan caadiga ahayn ee halista ah ee daroogada daaweynta hoormoonka ayaa hoos ku taxan.

Tamoxifen

• Khatarta xinjirowga dhiigga, gaar ahaan sambabaha iyo lugaha (12)

• Faalig (17)

• Cataracts (18)

• Kansarka Endometrial iyo makaanka (17, 19)

• Lafaha haweenka premenopausal

• Xaaladda isbeddela, niyadjabka, iyo luminta libido

• Ragga: madax xanuun, lallabbo, matag, finan maqaarka, awood la'aan, iyo xiisaha galmada oo yaraaday

Raloxifene

• Khatarta xinjirowga dhiigga, gaar ahaan sambabaha iyo lugaha (12)

• Faalig ku dhaca kooxo hoosaadyo gaar ah (17)

Xakamaynta ugxaanta

• Lafaha lafaha

• Xaaladda isbeddela, niyadjabka, iyo luminta libido

Kahortaga Aromatase

• Khatarta wadnaha wadnaha, angina, wadnaha oo istaaga, iyo hypercholesterolemia (20)

• Lafaha lafaha

• Xanuun wadajir ah (21-24)

• Niyad jabka iyo niyadjabka

Fulvestrant

• Calaamadaha caloosha (25)

• Xoog lumis (24)

• Xanuun

Daawooyinka kale ma faragelin karaan daaweynta hoormoonka?

Daawooyinka qaarkood, oo ay ku jiraan dawooyin badan oo daawada lidka ku ah (oo ku jira qaybta loo yaqaan 'serotonin reuptake inhibitors', ama SSRIs), ayaa xakameynaya enzyme loo yaqaan CYP2D6. Enzyme-kani wuxuu door muhiim ah ka ciyaaraa isticmaalka tamoxifen ee jirka maxaa yeelay wuxuu dheef-siiyaa, ama jajabaa, tamoxifen-ka merooleyaal, ama dheef-shiid kiimikaad, oo aad uga firfircoon tan tamoxifen lafteeda.

Suurtagalnimada in SSRIs laga yaabo, iyadoo la joojinayo CYP2D6, in la yareeyo dheef-shiid kiimikaadka 'tamoxifen' lana yareeyo waxtarkeeda waa walaac la qabo in inta badan afar meelood meel bukaanada kansarka naasaha ay la kulmaan niyad jab caafimaad oo lagu daaweeyo SSRIs. Intaas waxaa sii dheer, SSRIs waxaa mararka qaarkood loo isticmaalaa in lagu daaweeyo ololka kulul ee ay keento daaweynta hormoonka.

Khubaro badan ayaa soo jeedinaya in bukaanada qaadanaya daawada murugada ee ay weheliyaan tamoxifen ay tahay inay kala hadlaan xulashooyinka daaweynta dhakhaatiirtooda. Tusaale ahaan, dhakhaatiirtu waxay kugula talin karaan in laga beddelo SSRI oo ah ka hortag xoog leh ee CYP2D6, sida paroxetine hydrochloride (Paxil®), oo loo beddelo mid ka mid ah kuwa ka daciifka yar, sida sertraline (Zoloft®), ama aan lahayn waxqabadka xannibaadda ah, sida venlafaxine (Effexor®) ama citalopram (Celexa®). Ama waxay soo jeedin karaan in bukaankooda dhalmada kadib ay qaataan aromatase inhibitor halkii ay ka qaadan lahaayeen tamoxifen.

Daawooyinka kale ee joojiya CYP2D6 waxaa ka mid ah kuwan soo socda:

• Quinidine, oo loo isticmaalo daaweynta wadnaha aan caadiga ahayn

• Diphenhydramine, oo ah antihistamine

• Cimetidine, oo loo isticmaalo yareynta aashitada caloosha

Dadka loo qoro tamoxifen waa inay kala hadlaan isticmaalka dhammaan daawooyinka kale dhakhaatiirtooda.

Tixraacyo Xullan

1. Kohler BA, Sherman RL, Howlader N, iyo al. Warbixinta Sanadlaha ah ee Qaranka ee Xaaladda Kansarka, 1975-2011, oo muujinaysa dhacdooyinka noocyada kansarka naasaha noocyada / jinsiyadda, saboolnimada, iyo gobolka. Joornaalka Machadka Kansarka Qaranka 2015; 107 (6): djv048. doi: 10.1093 / jnci / djv048Exit Afeef.
2. Kooxda Wadajirka ee tijaabinta kansarka naasaha Hore (EBCTCG). Ku habboonaanta soo-saareyaasha hormoonka kansarka naasaha iyo arrimo kale oo ku saabsan waxtarka tamoxifen-ka: falanqaynta maadada heerka bukaanka ee tijaabooyinka la kala soocay Lancet 2011; 378 (9793) 771-784. [PubMed Abstract]
3. Untch M, Thomssen C. Go'aamada ku dhaqanka daaweynta ee daaweynta endocrine therapy. Baaritaanka Kansarka 2010; 28 Qalabka 1: 4-13. [PubMed Abstract]
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