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Women with high breast cancer risk should hear about preventive meds

Wednesday September 25, 2013
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Clinicians should engage in shared, informed decision-making with women who are at increased risk of breast cancer about preventive medications, while women who are not at higher risk should not use these medications, according to a final recommendation statement from the U.S. Preventive Services Task Force.

Under terms of the Affordable Care Act, the task force’s “B” recommendation means insurance companies must cover the full cost of these medications for women deemed to be at increased risk of breast cancer.

Risk factors for breast cancer include increasing age, family history of breast or ovarian cancer (especially among first-degree relatives and onset before age 50), history of atypical hyperplasia or other nonmalignant high-risk breast lesions, previous breast biopsy and extremely dense breast tissue.

In 2013, more than 232,000 women will be newly diagnosed with breast cancer, and nearly 40,000 women will die from it, 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 better treatments, better screening and, most importantly, better ways to prevent breast cancer. While we need better solutions, preventive medications offer some women at increased risk for breast cancer a way to reduce their chances of developing breast cancer.”

Evidence shows that, for women at high risk of developing ER-positive breast cancer, tamoxifen and raloxifene may reduce the risk. Women most at risk for getting breast cancer because of family history or other risk factors should weigh the benefits and harms of risk-reducing medications with their physician.

Tamoxifen and raloxifene have serious potential side effects, including thrombosis, increased risk for endometrial cancer and cataracts.

“While these medications have some significant side effects, it is important that clinicians and women at high risk for breast cancer be aware of the options these drugs offer,” said task force member Wanda Nicholson, MD, MBA. “Women should weigh the potential benefits and harms and consider their own values and preferences when making the decision about whether these medicines are the right choice for them.”

This final recommendation applies to women ages 35 and older who do not have signs or symptoms of breast cancer and who never have been diagnosed with breast cancer, ductal carcinoma in situ or lobular carcinoma in situ. In addition, the recommendation does not apply to women with a history of deep vein thrombosis, pulmonary embolism, strokes or transient ischemic attacks.

The recommendation aligns with the recommendations of medical organizations including the American Society of Clinical Oncology and the American Cancer Society.

Statement and supporting documents: www.uspreventiveservicestaskforce.org/uspstf/uspsbrpv.htm


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