+AA
Fr
McMasterLogo_New-2017-300x165
Back
Clinician Article

Use of medications to reduce risk for primary breast cancer: a systematic review for the U.S. Preventive Services Task Force.



  • Nelson HD
  • Smith ME
  • Griffin JC
  • Fu R
Ann Intern Med. 2013 Apr 16;158(8):604-14. doi: 10.7326/0003-4819-158-8-201304160-00005. (Review)
PMID: 23588749
Read abstract Read evidence summary Read full text
Disciplines
  • Public Health
    Relevance - 6/7
    Newsworthiness - 5/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 5/7
    Newsworthiness - 4/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 5/7
    Newsworthiness - 4/7
  • Oncology - Breast
    Relevance - 4/7
    Newsworthiness - 4/7

Abstract

BACKGROUND: Medications to reduce risk for primary breast cancer are recommended for women at increased risk; however, use is low.

PURPOSE: To update evidence about the effectiveness and adverse effects of medications to reduce breast cancer risk, patient use of such medications, and methods for identifying women at increased risk for breast cancer.

DATA SOURCES: MEDLINE and Cochrane databases (through 5 December 2012), Scopus, Web of Science, clinical trial registries, and reference lists.

STUDY SELECTION: English-language randomized trials of medication effectiveness and adverse effects, observational studies of adverse effects and patient use, and diagnostic accuracy studies of risk assessment.

DATA EXTRACTION: Investigators independently extracted data on participants, study design, analysis, follow-up, and results, and a second investigator confirmed key data. Investigators independently dual-rated study quality and applicability using established criteria.

DATA SYNTHESIS: Seven good- and fair-quality trials indicated that tamoxifen and raloxifene reduced incidence of invasive breast cancer by 7 to 9 cases in 1000 women over 5 years compared with placebo. New results from STAR (Study of Tamoxifen and Raloxifene) showed that tamoxifen reduced breast cancer incidence more than raloxifene by 5 cases in 1000 women. Neither reduced breast cancer-specific or all-cause mortality rates. Both reduced the incidence of fractures, but tamoxifen increased the incidence of thromboembolic events more than raloxifene by 4 cases in 1000 women. Tamoxifen increased the incidence of endometrial cancer and cataracts compared with placebo and raloxifene. Trials provided limited and heterogeneous data on medication adherence and persistence. Many women do not take tamoxifen because of associated harms. Thirteen risk-stratification models were modest predictors of breast cancer.

LIMITATION: Data on mortality and adherence measures and for women who are nonwhite, are premenopausal, or have comorbid conditions were lacking.

CONCLUSION: Medications reduced the incidence of invasive breast cancer and fractures and increased the incidence of thromboembolic events. Tamoxifen was more effective than raloxifene but also increased the incidence of endometrial cancer and cataracts. Use is limited by adverse effects and inaccurate methods to identify candidates.

PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

The relevance of this study is low because of the low use of these drugs for primary breast CA prevention. Additionally, the target group is very small; more effort spent on other modifiable risk factors (smoking, alcohol, exercise, obesity) can produce as much benefit without the significant side effects of (especially) tamoxifen and raloxifene.

Register for free access to all Professional content

Register
Want the latest in aging research? Sign up for our email alerts.
Subscribe

Support for the Portal is largely provided by the Labarge Optimal Aging Initiative. AGE-WELL is a contributing partner. Help us to continue to provide direct and easy access to evidence-based information on health and social conditions to help you stay healthy, active and engaged as you grow older. Donate Today.

© 2012 - 2020 McMaster University | 1280 Main Street West | Hamilton, Ontario L8S4L8 | +1 905-525-9140 | Terms Of Use