In a new recommendation, a group of respected cancer doctors said that women with high risk of developing breast cancer may have a new option for reducing that risk.
The recommendation put out by the US Preventive Services Task Force (USPSTF) says that women should consider taking tamoxifen, raloxifene, and aromatase inhibitors to lower the risk of breast cancer, if they are at high risk for the disease. A previous recommendation, released in 2013, stated that tamoxifen and raloxifene were useful in reducing risk of breast cancer for people with high-risk, but this recommendation adds aromatase inhibitors to the list of risk-reducing drugs.Read More
The recommendation draws on findings from more than 5 million women, who participated in 46 studies. were associated with lower rates of breast cancer in women with a high risk of developing the disease.
Doctors are able to make some assessments of risk for breast cancer based on a few observable factors, “We perform a personalized risk-benefit analysis on all women seen in our cancer risk evaluation clinic that incorporates family history, breast density, reproductive history and prior benign breast biopsy results. We routinely recommend medications to reduce breast cancer risk for women at high risk of breast cancer,” says Dr. Maxwell.
But there are still some problems with determining which women fall into the “high-risk” category, because many women who don’t have easily detectable genetic mutations may still be at risk.
“The major outstanding issue in the field, however, is the need for better individualized breast cancer risk assessment tools in women without BRCA1/2 mutations to more accurately identify those women who truly are in the “high risk category," says Dr. Maxwell. “For example, models are needed using 10-year risk instead of lifetime risk and those incorporating low to moderate risk genetic variants.”
The recommendation says that all women with a 3 percent risk of getting breast cancer in the next five years should consider these medications, but notes that risk assessment tools are not perfect.
Information about tamoxifen
Tamoxifen gets a very bad rap that's the long and short of it but it's been around for a long time and is very effective. Tamoxifen is a selective estrogen receptor modulator which means it works to prevent estrogen from helping cancer cells to grow. It is also used to prevent breast cancer among women who are high-risk for breast cancer because of family history.
Dr. Elizabeth Comen, Medical Oncologist at Memorial Sloan Kettering Cancer Center, on tamoxifen for reducing risk of breast cancer
There are side effects for some patients, many of which mimic menopause (like hot flashes), but they can be managed. Tamoxifen is a commitment. For women who have been diagnosed with breast cancer, patients are typically put on the tamoxifen pill for five to 10 years and there is evidence that taking it for 10 years is more effective than taking it for five. In addition, it's a treatment that when taken alone or in combination with chemotherapy reduces the chance of having a breast cancer spread.
Bottom line: before believing the negatives about Tamoxifen, be sure to do your research. And remember, everyone responds differently to medications, just as everyone is at a different risk level for breast cancer in general. The best way to learn more about this medication and your risks for breast cancer, consult with your doctor at your next regularly scheduled mammogram.
Options for people with a high-risk of breast cancer
Specific mutations in BRCA genes lead to an increased risk of developing breast cancer. People who have a family history of breast or ovarian cancer may want to consider being tested for mutations, particularly if the relative was diagnosed with cancer before age 50. If you've been diagnosed with a BRCA mutation, there are still steps you can take to lower your risk of developing a cancer.
Dr. Freya Schnabel, Director of Breast Surgery at NYU Langone Medical Center, on options for people with a high risk of developing breast cancer
"When I meet with women who are at an increased risk for breast cancer because of BRCA mutations, I like to talk about the three options that they have for managing their risk," says Dr. Freya Schnabel, Director of Breast Surgery at NYU Langone Medical Center. Those options are:
- Intensive surveillance: This means keeping an eye on your health, in an attempt to catch disease early if it does present itself.
- Medication: There are certain drugs available to lower the risk of developing breast cancer. But as with any medical treatment, risks and benefits must be considered.
- Surgery: This is the option that will lower a woman's chance of getting breast cancer as much as possible. It involves removing as much breast tissue as possible, while attempting to preserve the nipple area, should a woman opt for reconstruction.