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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Using Medication To Prevent Breast Cancer: Recommendations from the United States Preventive Services Task Force
2 July 2002 | Volume 137 Issue 1 | Page I-62
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians-American Society of Internal Medicine.
The summary below is from the full reports titled "Chemoprevention of Breast Cancer: Recommendations and Rationale" and "Chemoprevention of Breast Cancer: A Summary of the Evidence for the U.S. Preventive Services Task Force." They are in the 2 July 2002 issue of Annals of Internal Medicine (volume 137, pages 56-58 and pages 59-67). The first report was written by the U.S. Preventive Services Task Force; the second report was written by LS Kinsinger, R Harris, SH Woolf, HC Sox, and KN Lohr.
What is the United States Preventive Services Task Force?
The United States Preventive Services Task Force (USPSTF) is a group of physicians and other health care experts that reviews published research and makes recommendations about preventive health care.
What is the problem and what is known about it so far?
Breast cancer is a common type of cancer among women in the United States. Despite improvements in early detection and treatment, about 39,600 American women will die of breast cancer in 2002. Chemoprevention is a strategy for reducing the risk for cancer ("prevention") by taking drugs ("chemo"). The drug tamoxifen reduces the risk for a second episode of breast cancer in women who have already had breast cancer. Some evidence indicates that tamoxifen and a similar drug, raloxifene, can prevent breast cancer in women who have never had the disease. Of note, the U.S. Food and Drug Administration has approved only tamoxifen for the prevention of breast cancer. However, these drugs also have side effects that include hot flashes, vaginal discharge, and sexual problems, and they increase the risk for cancer of the uterus, stroke, cataracts, and blood clots. Women must weigh the potential benefits of chemoprevention for breast cancer against these risks of taking the drugs.
How did the USPSTF develop these recommendations?
The USPSTF reviewed published research to evaluate the benefits and harms of using medication to prevent breast cancer.
What did the authors find?
The USPSTF found three high-quality studies that used tamoxifen and one that used raloxifene. Taken together, these studies suggest that tamoxifen and raloxifene substantially reduced the risk for a first episode of breast cancer in women who had a 1.66% (1.66 out of 100) or greater risk for developing the disease in the next 5 years. The reduction was only in types of breast cancer that are especially sensitive to estrogens. Both drugs increased the risk for blood clots and hot flashes. Tamoxifen also increased the risk for stroke and cancer of the uterus.
What does the USPSTF suggest that patients do?
Women at low or average risk for breast cancer should not routinely use tamoxifen or raloxifene to prevent breast cancer. Women with risk factors for breast cancer should discuss the potential benefits and harms of tamoxifen and raloxifene with their doctors. The strongest risk factors for breast cancer are older age; family history of breast cancer in a mother, sister, or daughter; and a breast biopsy that shows an abnormality called atypical hyperplasia. Women can estimate their risk for developing breast cancer in the next 5 years by using the National Cancer Institute Breast Cancer Risk Tool (available at http://cancer.gov/bcrisktool or by calling 800-4-CANCER). A woman is least likely to suffer the side effects of chemoprevention if she is under age 50, has no special risk for blood clots or stroke, and has no uterus. Women should talk with their physicians about chemoprevention of breast cancer, especially if they are young, at high risk for breast cancer, and at low risk for blood clots.
What are the cautions related to these recommendations?
The Breast Cancer Risk Tool has not been studied in primary care settings. The recommendations are based on relatively few studies of chemoprevention for breast cancer. As more studies become available, the USPSTF may modify these recommendations.
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