Well, new in the last 30 years. Selective Estrogen Receptor Modulators (SERM) do prevent breast cancer! This finding has been reconfirmed in a recent Lancet publication http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60140-3/abstract.
These investigators, led by Dr Jack Cuzick at the Center for Cancer Prevention at Queen Mary University London, performed a meta-analysis of data from 9 breast cancer prevention trials using 4 SERMS (some call these estrogen [receptor] blockers), looking at breast cancer incidence at a median follow-up of 65 months. Two of the SERM's may be familiar to you: tamoxifen and raloxifene(Evista); but studies with arzoxifene and lasoxifene were also included.
They analyzed data from 83,399 women in 306,617 women-years of follow-up! Overall they report a 38% reduction in breast cancer incidence. 38% did not get breast cancer! We know the drugs work, so now the key is to find out who would benefit and what is the risk.
Today, there are general guidelines, which differ by country, which basically state that those of higher risk should be offered the medicine. Interestingly, in the US the "break-point" for recommendation falls around 20% life-time risk (population life-time risk for breast cancer risk is 12%) and in the UK, at 30% risk.
Several drugs may be used in postmenopausal women but only tamoxifen is approved for use in the premenopausal woman. Each has unique side effects and risks and at least one is approved for another beneficial use (maintaining bone health).
Now the exciting part; just as cardiologists can tell whether a statin drug may be "working" by following cholesterol levels, we now may have a biomarker for efficacy of a SERM. Imagine, giving the medicine only to those who benefit most! Personalized medicine! Basing your decision to continue the medicine on information about its efficacy in you and not just the population at large, statistical, benefit!
The first biomarker discovered is breast density. We will discuss the effect of breast density on breast cancer risk and the change in breast density on the effectiveness of the SERM's next week! Then how the SERM's work and finally how to individualize the prescription, weighing benefits vs risks. Check back!
Together we can prevent 86,000 breast cancer cases this year.
This is general content and not personal medical advice.
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