Breast cancer: Task force may recommend drugs for high-risk women

April 19, 2013 | by Hiu Chung So

Currently, the official guidelines to reduce breast cancer risk are primarily a set of lifestyle habits such as eating a healthier diet, exercising regularly and getting the recommended screenings. But what if the prescription to prevent breast cancer included actual drugs?

Women at an elevated risk of developing breast cancer, should be offered drugs, such as tamoxifen or raloxifene, to reduce that risk, the U.S. Preventive Services Task Force suggests. Women at an elevated risk of developing breast cancer should be offered drugs such as tamoxifen or raloxifene to reduce that risk, the U.S. Preventive Services Task Force suggests.

That just might be the case for some women, specifically those at an elevated risk of breast cancer, according to a draft recommendation made by the United States Preventive Services Task Force (USPSTF).

The report, which is still being developed and open for public comment until May 13, recommends: “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."

Both drugs work by blocking estrogen’s effect on breast tissue, and approximately 75 percent of breast cancers are fueled by estrogen.

However, these drugs also have serious side effects, such as increasing the risk of blood clots, strokes and, for tamoxifen, cataracts and endometrial cancers. Thus, the USPSTF report also notes that “women who are not at increased risk for breast cancer should not use tamoxifen or raloxifene to reduce their risk for breast cancer.”

Joanne Mortimer, M.D., director of City of Hope's Women's Cancers Program, brought up another point, one that could amount to a caveat.

“These drugs prevent the development of hormone-sensitive breast cancers but have not been shown to reduce the risk of dying from breast cancer,” she said. Further, she added: “Few women opt to receive ‘chemoprevention’ with either drug” due to potential side effects.

The report acknowledges that most women identified as high risk will not develop breast cancer, perhaps limiting the widespread appeal, or impact, of this recommendation.

In the meantime, as the USPSTF recommendations are being revised and finalized, many women will simply stick to already proven methods to reduce breast cancer risk. According to the federal Centers for Disease Control and Prevention, this includes regular screening, maintaining a healthy weight, exercising regularly, limiting alcohol intake and evaluating family history of breast cancer and hormone replacement therapy with a clinician.

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