As pacientes que apresentam mutação BRCA1/2 tem risco de até 70% desenvolver câncer de mama, porém a adenomastectomia e a salpingo-oforectomia bilateral nas pacientes pré-menopausadas reduz este risco em 90 e 50% respectivamente. Entretanto nem todas as mulheres querem ser submetidas a um procedimento cirúrgico e, para esses casos, existe a terapia medicamentosa, que pode reduzir o risco em até 40% nas pacientes de risco alto, havendo, aproximadamente, 50% de possibilidade de um segundo tumor na mama.
O estudo realizado por Phillips et al., analisou o uso adjuvante de tamoxifeno, modulador seletivo do receptor de estrógeno, para reduzir o risco de recidiva contralateral nas pacientes com diagnóstico de câncer de mama e que apresentam a mutação.
Live Casino Bliss: Australia’s Top Picks
Welcome to the world of live casinos, where the thrill of playing your favorite casino games is taken to a whole new level. In recent years, live casinos have become increasingly popular among Australian players, offering an immersive and authentic gambling experience from the comfort of your own home. With so many options to choose from, it can be overwhelming to find the best live casino for your needs. That’s why we’ve put together this guide to help you navigate through Australia’s top picks for live casinos.
1. The Crown Casino
Located in Melbourne, The Crown Casino is one of the most prestigious and well-known casinos in Australia. With a dedicated live casino section, players can enjoy a wide range of live dealer games, including blackjack, roulette, and baccarat. The live casino at The Crown Casino offers a seamless streaming experience, with professional dealers and high-quality video feeds. Whether you’re a seasoned player or new to live casinos, The Crown Casino is sure to provide you with an unforgettable gaming experience.
If you want to learn more about The Crown Casino’s live casino offerings, read more here.
2. The Star Sydney
Situated in Sydney, The Star is another top choice for live casino enthusiasts in Australia. With a dedicated live casino section, The Star offers a wide variety of live dealer games, including popular options like roulette, blackjack, and poker. The live casino at The Star is known for its immersive gameplay and high-quality streaming, allowing players to feel like they’re sitting at a real casino table. Whether you’re a high roller or a casual player, The Star Sydney has something for everyone.
If you’re interested in exploring The Star Sydney’s live casino offerings further, read more here.
3. JokaRoom Casino
If you’re looking for a more modern and innovative live casino experience, JokaRoom Casino is the perfect choice. With a sleek and user-friendly interface, JokaRoom Casino offers a wide range of live dealer games, including blackjack, roulette, and baccarat. The live casino at JokaRoom Casino is powered by leading software providers, ensuring a seamless and high-quality streaming experience. With its generous bonuses and promotions, JokaRoom Casino is a popular choice among Australian players.
To find out more about JokaRoom Casino’s live casino offerings, read more here.
Conclusion
Live casinos have revolutionized the way we play and experience online gambling. With their immersive gameplay, professional dealers, and high-quality streaming, live casinos offer an authentic casino experience from the comfort of your own home. Whether you prefer the prestige of The Crown Casino, the excitement of The Star Sydney, or the modernity of JokaRoom Casino, Australia has a wide range of top-notch live casinos to choose from. So, why wait? Dive into the world of live casino bliss and start enjoying the thrill of live dealer games today!
Foram selecionadas 1.583 mulheres com BRCA1 e 881 com BRCA2 mutados e o uso de tamoxifeno a partir de dois bancos de dados. No geral, 520 mulheres desenvolveram recidiva contralateral após iniciar o uso da medicação. Na análise retrospectiva, aquelas com mutação BRCA1, o risco foi de 0,38 (p<0,001) e nas com BRCA2 mutado, 0,33 (p<0,001), entretanto, na análise prospectiva, não houve diferença significativa.
O tamoxifeno pode ser utilizado para reduzir o risco de câncer na mama contralateral nas pacientes portadoras da mutação BRCA1 e BRCA2, segundo análise retrospectiva, mas não se pode afirmar que a terapia medicamentosa realmente substituirá o procedimento cirúrgico, sendo assim, estudos futuros devem ser realizados para melhor definição.
Referência:
Phillips KA, Milne RL, Rookus MA, et al. Tamoxifen and risk of contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. J Clin Oncol 2013;31(25):3091-9.
ANDRÉA M. FERRIAN
(Fellow Oncologia Clínica do Centro Oncológico Antônio Ermírio de Moraes)
