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Systematic Review: Comparative Effectiveness of Medications to Reduce Risk for Primary Breast Cancer
Annals of Internal Medicine, 09/15/09

Nelson HD et al. – Three medications reduce risk for primary breast cancer but increase risk for thromboembolic events (tamoxifen, raloxifene), endometrial cancer (tamoxifen), or stroke (tibolone).

Methods

MEDLINE and Cochrane databases from inception to January 2009, Web of Science, trial registries, and manufacturer information were searched. English–language reports of randomized, controlled trials (RCTs) for benefits and RCTs and observational studies for harms were included.
Two reviewers assessed study data, quality, and applicability.

Results

Seven placebo–controlled RCTs and 1 head–to–head trial provide results for main outcomes.
Tamoxifen, raloxifene, and tibolone reduce risk for invasive breast cancer compared with placebo by 7 to 10/1000 women per year.
Tamoxifen and raloxifene reduce estrogen receptor–positive breast cancer, but not estrogen receptor–negative breast cancer, noninvasive breast cancer, or mortality; all medications reduce fractures.
Tamoxifen and raloxifene increase thromboembolic events by 4 to 7/1000 women per year; raloxifene causes fewer events than tamoxifen.
Tamoxifen increases risk for endometrial cancer compared with placebo by 4/1000 women per year and causes cataracts compared with raloxifene.
Tibolone causes strokes in older women.

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