I will discuss the benefits as well as safety information for this drug. This blog is intended to educate and provoke a discussion with your doctor. It might be the right prescription for you.
Evista is a selective estrogen receptor modulator(SERM) like tamoxifen. Basically a SERM "turns down" the estrogen receptors in the breast leading to fewer breast cancers in those taking the drug and "turns up" the estrogen receptors in the bones leading to increased bone mineral density and reduced risk for vertebral fractures. It is one of the most studied drugs; in multiple trials of almost 40,000 women. Over 64 million prescriptions have been written.
Who should consider Evista?
It is indicated only for postmenopausal women (whose ovaries either don't make estrogen or have been removed) to:
- treat and prevent osteoporosis
- decrease the risk of invasive breast cancer in women with osteoporosis
- decrease the risk of invasive breast cancer in women who are high risk.
The bone part is easy to assess: history of fracture and bone mineral density.
The high risk for breast cancer requires more consideration, the kind we discuss at almost every visit. The factors that I consider are:
- family history (mother, daughter, sister increase the risk the most)
- previous breast biopsies, particularly finding atypical cells
- lobular carcinoma in-situ
- late (particularly >30 yo) or no full term pregnancy
- early first menstrual cycle (<11 years)
- prolonged use of combined estrogen and progesterone hormones
- greater than average breast density
- age (the risk continues to climb the further you get from 20 yo).
If you have any of these, you should consider Evista with your doctor.
What about side effects? Although the safety has been demonstrated in several trials Evista isn't for everyone. The most important safety information is in the Boxed Warning: increased risk of venous thomboembolism (a clot in the leg that may then break off and go the lung) and death from a stroke in women with coronary artery disease. If you have had deep vein thrombosis, you should not take it. If you have coronary artery disease, then you need to consider risk/benefit value with your doctor.
The major adverse reactions are hot flashes and leg cramps. We have options to help with these that are non hormonal and non prescription.
In summary, Evista is powerful medicine and one of the drugs that I use to prevent breast cancer. Check with your doctor to find out if it is right for you. Learn more at http://www.evista.com/Pages/index.aspx.
Together, we can prevent 75,000 breast cancer cases per year!
When I talk about Evista I am obliged to remind everyone that I am a Faculty Resource for the Lilly Lecture Bureau (the company that makes the drug).
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