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USPSTF issues guidelines on breast cancer meds

Tuesday April 16, 2013
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The U.S. Preventive Services Task Force has posted a draft recommendation statement on the use of medications for risk reduction of primary breast cancer in women.

More than 232,000 women will be newly diagnosed with breast cancer in 2013, according to the National Cancer Institute, making it the most common non-skin cancer in women. "Screening for breast cancer allows for early detection but does not prevent cancer from developing," task force member Mark Ebell, MD, MS, said in a news release.

"We all want to find effective ways to prevent breast cancer. While we need more and better solutions, some women at increased risk for breast cancer may choose to take available preventive medications to reduce their chances of developing breast cancer."

Women who have a family history of breast cancer or are concerned about their risk of breast cancer should discuss their risk with a healthcare professional, according to the draft recommendation. After conducting a formal risk assessment, physicians should talk with women at increased risk about the harms and benefits of taking a risk-reducing medication, such as tamoxifen or raloxifene. For women at increased risk of breast cancer and low risk of harm from the medications, the medications may provide benefit.

Tamoxifen and raloxifene are selective estrogen receptor modulators, which block the effects of estrogen in the breast tissue. They have been shown to reduce the risk of hormone receptor-positive breast cancer.

Possible harms from the medications include an increased risk of venous thromboembolic events and, in the case of tamoxifen, an increased risk of endometrial cancer. Both medications — more so tamoxifen — may raise the risk of ischemic stroke.

"There are several serious harms associated with tamoxifen and raloxifene, which is why doctors must engage in a conversation with their patients and discuss the harms and benefits of these medications to reduce the risk of breast cancer," said task force member Wanda Nicholson, MD, MPH, MBA. "Because of these harms, the task force recommends against the use of these medications for women who are not at increased risk for breast cancer."

The task force noted its recommendation is consistent with that of other credible groups and organizations, including the American College of Obstetricians and Gynecologists and the American Cancer Society, and with accepted clinical practice.

The draft recommendation applies to women ages 40 to 70 who do not have signs or symptoms of breast cancer and never have been diagnosed with breast cancer or DCIS. The recommendation does not apply to women with a history of blood clots, including deep vein thrombosis, pulmonary embolism, strokes or mini-strokes.

Public comments on the draft recommendation will be accepted until May 13 and considered as the task force completes its final recommendation. Links to the draft recommendation and other recommendations that are open for comment are available at www.uspreventiveservicestaskforce.org/tfcomment.htm.


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