Annals of Internal Medicine
Using Medications to Decrease the Risk for Breast Cancer in
Women: Recommendations From the U.S. Preventive Services
Who developed these recommendations?
The U.S. Preventive Services Task Force (USPSTF) developed these recommendations.
The USPSTF is a group of physicians and other health care experts that makes
recommendations about preventive health care.
What is the problem and what is known about it so far?
More than 39,600 American women will die of breast cancer in 2013. The strongest risk
factors for breast cancer are older age, family history of breast or ovarian cancer (especially
in a mother, sister, or daughter before age 50 years), previous breast biopsy (especially if
results showed an abnormality called “atypical hyperplasia”), and extremely dense breast
tissue. Chemoprevention is a strategy for reducing the risk for cancer by taking drugs.
Some evidence indicates that tamoxifen and a similar drug, raloxifene, can prevent breast
cancer in women who have never had the disease. However, these drugs also have adverse
effects, including hot flashes, and they increase the risk for uterine cancer, cataracts, andblood clots. Women must weigh the potential benefits of chemoprevention for breast
cancer against these risks. The USPSTF last issued recommendations on breast cancerchemoprevention in 2002.
How did the USPSTF develop these recommendations?
The USPSTF reviewed research published since 2002 to evaluate the benefits and harms of
using medication to prevent breast cancer.
What did the authors find?
The USPSTF found evidence that tamoxifen or raloxifene can reduce the risk for certain
types of breast cancer in postmenopausal women who are at increased risk for the disease.
Tamoxifen seems to reduce risk more than raloxifene. Tamoxifen also reduces breast
cancer risk in high-risk premenopausal women. For women who are not at increased risk,
chemoprevention’s benefits are no greater than small.
The harms of tamoxifen and raloxifene include hot flashes and blood clots.
Tamoxifen, but not raloxifene, also increases the risk for uterine cancer, particularly inwomen older than 50 years who have a uterus. Tamoxifen may also increase the risk forcataracts.
What does the USPSTF recommend that patients and doctors do?
Women at low or average risk for breast cancer should not routinely use tamoxifen or
raloxifene to prevent breast cancer.
Women with risk factors for breast cancer should discuss the potential benefits and
harms of tamoxifen and raloxifene with their physicians. A woman is least likely to
Summaries for Patients
are a service
experience the adverse effects of chemoprevention if she is younger than 50 years, has no
provided by Annals
to help patients
special risk for blood clots or stroke, and has no uterus. Physicians should offer
chemoprevention to women at high risk for breast cancer and at low risk for blood clots.
and often mystifying language ofmodern medicine.
What are the cautions related to these recommendations?
Available information is limited about the effectiveness of methods for estimating a
Summaries for Patients are presented for infor-
woman’s breast cancer risk and identifying candidates for chemoprevention.
mational purposes only. These summaries arenot a substitute for advice from your ownmedical provider. If you have questions aboutthis material, or need medical advice aboutyour own health or situation, please contactyour physician. The summaries may be repro-duced for not-for-profit educational purposesonly. Any other uses must be approved by theAmerican College of Physicians.
2013 American College of Physicians
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