New Preventative Drugs Guidelines Released for Women with High Risk of Breast Cancer
Earlier this summer, the American Society of Clinical Oncology (ASCO) released new guidelines for women categorized as “high-risk” for breast cancer. In some women, experts estimate the risk of breast cancer could be reduced by up to 50% after taking certain medications.
The guidelines aren’t geared toward all women, or women who currently have breast cancer. Rather, candidates may include women in their 40s who have atypical hyperplasia (an abnormality in breast cells linked with higher risk of breast cancer), women in their 50s, who have not given birth but do have a family history of breast cancer, and women with the BRCA1 and BRCA2 gene mutations. Furthermore, the guidelines don’t necessarily recommend that these at-risk women take the drugs, only that they discuss them with their physician as one of the possible options for reducing their risk of breast cancer.
The Recommendations In The Guideline
According to an August 2013 article in Clinical Oncology News, the key recommendations in the guideline update are as follows:
- Tamoxifen (20 mg per day orally for five years) should be discussed as an option to reduce the risk for invasive, estrogen receptor (ER)-positive breast cancer in premenopausal or postmenopausal women. Tamoxifen targets the estrogen receptor in breast tissue, and therefore is only effective for prevention of ER-positive breast cancer.
- Raloxifene (60 mg per day orally for five years) also should be discussed as an option to reduce the risk for invasive, ER-positive breast cancer. It targets the estrogen receptor in breast tissue. Its use is limited to postmenopausal women.
- Exemestane (25 mg per day orally for five years) should be discussed as an alternative to reduce the risk for invasive, ER-positive breast cancer in postmenopausal women. It is an aromatase inhibitor, a class of drugs that lower the amount of estrogen in postmenopausal women and are given to women with ER-positive breast cancer after surgery to lower the risk for cancer recurrence. Although exemestane is approved for the treatment of breast cancer, the FDA has not yet approved its use in breast cancer prevention. This recommendation is based on encouraging data from a single clinical trial that showed a reduction of up to 70% in overall and ER-positive invasive breast cancer incidence for exemestane compared with placebo over a three-year period.
- All three agents should be discussed (including risks and benefits) with women aged 35 years or older without a personal history of breast cancer who are at increased risk for developing invasive breast cancer, based on risk factors such as the woman’s age, race, and medical and reproductive histories.
The medications discussed may cause side effects including hot flashes, vaginal dryness and decreased sex drive. As the guidelines suggest, women who are in this high-risk group should talk with their physician about the risks and benefits of taking these drugs and then ultimately make the decision that is best for them.
If you fit into this category or have questions about any of the drugs mentioned in the recommendations, please feel free to speak with any of our pharmacists.