Tuesday, February 28, 2012

Review of Chemoprevention for Breast Cancer

A recent review of chemoprevention trials for breast cancer was recently published online http://www.medscape.com/viewarticle/758953?src=nl_topic and I will summarize here.


There are now 3 FDA approved prescription drugs used for breast cancer prevention.  They are tamoxifen, raloxifene (Evista) and most recently exemastane (Aromasin).  There is ample evidence to support the use of these drugs since they have clearly been shown to decrease the numbers of breast cancers in all of the trials in high risk women.


First of all they have great names (all acronyms): NSABP P-1, IBIS I, CORE, MORE, STAR and NCIC CTG MAP.3.  


Important points:
  • study time 1992- 2010
  • over 50,000 women total in trials
  • shortest trial reported 3 years
  • Breast Cancer reduction is overall 50%
  • reduction seems to be the same for each agent
Wow! So it has been demonstrated many times and with many women that the drugs do reduce breast cancer incidence, but are there other issues?

Yes!  Risks and quality of life issues.


The major risks:

  • tamoxifen: blood clots and uterine cancer
  • raloxifene: blood clots
  • exemastane: bone loss, fatigue and joint pain
They each may cause vasomotor symptoms like hot flashes and night sweats.  Other side effects have been noted, but these are the most common.

It is estimated that 5 million US women could benefit from these medicines, but again this is an issue for you to discuss with your doctor.  I have provided some general information to begin the discussion if you are at high risk, but actual treatment decisions need to be made by you and your doctor.


Remember that everyone can benefit from being lean, not being sedentary and exercising regularly.


Together we can prevent 75,000 breast cancer cases each year!


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