Patients reading or hearing about the updated draft recommendation statement from the U.S. Preventive Services Task Force (USPSTF) on the use of medications to reduce risk for primary breast cancer1 may ask if and how it applies to them. To help answer those questions, the information presented below was compiled from the draft recommendation statement and a supporting fact sheet,2 and a systematic review of studies on the use of medications to reduce the risk for primary breast cancer.3
What are the draft recommendations?
The U.S. Preventive Services Task Force recommends:
Clinicians engage in shared decision-making with women at increased risk of breast cancer about medications to reduce their risk.
For women who are at increased risk for breast cancer and at low risk for adverse medication effects, clinicians should offer to prescribe risk-reducing medications such as tamoxifen or raloxifene (Evista).
Women who are not at increased risk for breast cancer should not routinely use medications such as tamoxifen or raloxifene.
What were the major findings of the systematic review of clinical trials of tamoxifen and raloxifene?
The systematic review included seven randomized, controlled trials—four with tamoxifen, two with raloxifene, and one comparing tamoxifen and raloxifene, the Study of Tamoxifen and Raloxifene (STAR). The review concluded that both medications reduced the incidence of invasive breast cancer and fractures and increased the risk of thromboembolic events. Tamoxifen was more effective than raloxifene in reducing breast cancer risk but also increased the risk of endometrial cancer and cataracts.
Who does the draft recommendation statement apply to?
The draft recommendation statement applies to asymptomatic women between the ages of 40 and 70 who have not been diagnosed with breast cancer, ductal carcinoma in situ (DCIS), or lobular carcinoma in situ (LCIS).
Because tamoxifen and raloxifene were found to increase the risk of thromboembolic events, the draft recommendation on the use of tamoxifen and raloxifene to reduce the risk of primary breast cancer does not apply to women who have a history of thromboembolic events, such as deep venous thrombosis, pulmonary embolus, stroke, or transient ischemic attack. ■
1. Medications for risk reduction of primary breast cancer in women: U.S. Preventive Services Task Force recommendation statement draft. April 2013. Available at www.uspreventiveservicestaskforce.org.
2. Commenting on Task Force Draft Recommendations: U.S. Preventive Services Task Force. April 2013. Available at www.uspreventiveservicestaskforce.org.
3. Nelson HD, Smith MEB, Griffin JC, et al: Use of medications to reduce risk for primary breast cancer: A systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 158:604-614, 2013.
Clinicians should engage in shared decision-making with women who are at increased risk of breast cancer about using medications, such as tamoxifen and raloxifene (Evista), to reduce risk, and should offer prescriptions to women considered at low risk for adverse effects from these medications,...