American Society of Clinical Oncology Clinical Practice Guideline update on the use of pharmacologic interventions including tamoxifen, raloxifene, and aromatase inhibition for breast cancer risk reduction
Visvanathan K et al. - In a study to update the 2002 American Society of Clinical Oncology guideline on pharmacologic interventions for breast cancer (BC) risk reduction, it was determined that in women at increased risk for BC, tamoxifen (20 mg/d for 5 yrs) may be offered to reduce risk of invasive ER-positive BC, with benefits for at least 10 yrs. In postmenopausal women, raloxifene (60 mg/d for 5 yrs) may also be considered. Use of aromatase inhibitors, fenretinide, or other selective estrogen receptor modulators to lower BC risk is not recommended outside of a clinical trial. Discussion of risks and benefits of preventive agents is critical to pt decision making. Methods- A literature search identified relevant randomized trials published since 2002.
- Primary outcome of interest was BC incidence (invasive and noninvasive).
- Secondary outcomes included BC mortality, adverse events, and net health benefits.
- An expert panel reviewed the literature and developed updated consensus guidelines.
Results- 17 articles met inclusion criteria.
- In premenopausal women, tamoxifen for 5 yrs reduces risk of BC for at least 10 yrs, particularly estrogen receptor (ER) –positive invasive tumors.
- Women ≤50 yrs of age experience fewer serious side effects.
- Vascular and vasomotor events do not persist post-treatment across all ages.
- In postmenopausal women, raloxifene and tamoxifen reduce the risk of ER-positive invasive BC with equal efficacy.
- Raloxifene is associated with a lower risk of thromboembolic disease, benign uterine conditions, and cataracts than tamoxifen in postmenopausal women.
- No evidence exists establishing whether a reduction in BC risk from either agent translates into reduced BC mortality.
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