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Onco Targets Ther. 2019 Jun 24;12:4937-4953. doi: 10.2147/OTT.S183192. eCollection 2019.

Dissecting the prevention of estrogen-dependent breast carcinogenesis through Nrf2-dependent and independent mechanisms.

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Epidemiology Unit, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Naples, Italy.
S.S.D Sperimentazione Animale, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Naples, Italy.
Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori "Fondazione G. Pascale", IRCCS, Naples, Italy.
Hematology and Stem Cell Transplantation Unit, IRCCS Centro di Riferimento Oncologico della Basilicata, Rionero in Vulture, Italy.
Department of Experimental Medicine, Università della Campania "Luigi Vanvitelli", 80134 Naples, Italy.
Scientific Direction, Istituto Nazionale Tumori-IRCCS "Fondazione G. Pascale", Naples, Italy.
Department of Biochemistry, Biophysics and General Pathology, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, 84081 Salerno, Italy.


Breast cancer is the most common malignancy among women worldwide. Various studies indicate that prolonged exposure to elevated levels of estrogens is associated with development of breast cancer. Both estrogen receptor-dependent and independent mechanisms can contribute to the carcinogenic effects of estrogens. Among them, the oxidative metabolism of estrogens plays a key role in the initiation of estradiol-induced breast cancer by generation of reactive estrogen quinones as well as the associated formation of oxygen free radicals. These genotoxic metabolites can react with DNA to form unstable DNA adducts which generate mutations leading to the initiation of breast cancer. A variety of endogenous and exogenous factors can alter estrogen homeostasis and generate genotoxic metabolites. The use of specific phytochemicals and dietary supplements can inhibit the risk of breast cancer not only by the modulation of several estrogen-activating enzymes (CYP19, CYP1B1) but also through the induction of various cytoprotective enzymes (eg, SOD3, NQO1, glutathione S-transferases, OGG-1, catechol-O-methyltransferases, CYP1B1A, etc.) that reestablish the homeostatic balance of estrogen metabolism via nuclear factor erythroid 2-related factor 2 (Nrf2)-dependent and independent mechanisms.


breast carcinogenesis; depurinating estrogen–DNA adducts; dietary phytochemicals; nuclear factor erythroid 2-related factor 2; reactive estrogen quinones

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The authors report no conflicts of interest in this work.

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