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Word of the Day

USPSTF: Offer medication to prevent breast cancer to women at risk

Clinical Question:
Should women at increased risk of breast cancer be offered medication to reduce their risk?

Bottom Line:
Based on a moderate certainty of a moderate effect, the United States Preventive Services Task Force (USPSTF) recommends offering either tamoxifen or raloxifene to women (without the BRCA gene mutation) who are at increased risk of developing breast cancer. For every 1000 women taking this preventive therapy, 7 to 9 breast cancers will be prevented and 4 to 7 thromboembolic events will occur. This recommendation is unchanged from their 2002 statement. The task force suggests not offering preventive therapy for women at average (typical) risk. (LOE = 5)

Reference:
Moyer VA, on behalf of the U.S. Preventive Services Task Force. Medications for risk reduction of primary breast cancer in women: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2013;159:698-708.  [PMID:24061472]

Study Design:
Practice guideline

Funding:
Government

Setting:
Various (guideline)

Synopsis:
This recommendation is an update of the 2002 guideline of the USPSTF. It applies to asymptomatic women at least 35 years of age without a prior diagnosis of breast cancer, ductal carcinoma in situ, or lobular carcinoma in situ. Separate guidelines are available for women with the BRCA gene mutation. The USPSTF recommends, following discussion, tamoxifen or raloxifene for women at increased risk of developing breast cancer and at low risk for adverse effects (B recommendation; moderate certainty of moderate benefit). Women at an increase risk of adverse effects are those with a history of thromboembolic events. Overall, the incidence of invasive breast cancer will be decreased by 7 to 9 women for every 1000 treated. Risk can be assessed using the Gail Risk model (a tool is available at www.cancer.gov/bcrisktool). In women at low risk for adverse effects, between 4 and 7 women out of every 1000 treated will experience a thromboembolic event. The Task Force recommends against offering preventive treatment for women at low or average risk of breast cancer (D recommendation).

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