Healthy Women Now Considering Drugs to Prevent Breast Cancer – Should You?
New guidelines released last month by the American Society of Clinical Oncology (ASCO) suggest women at elevated risk for breast cancer should discuss with their doctor “chemopreventive” drugs – drugs designed to prevent breast cancer, rather than treat it. This new recommendation covers women beyond those who’ve tested positive for the BRCA genes. Do you fall into this newly designated high-risk group?
One of America’s most highly respected medical societies has just changed the playing field for American women concerned about breast cancer. Which would be (or should be) just about every woman in this country, given breast cancer is the second most diagnosed cancer in women, after lung cancer.
We all know that our lifetime risk of having breast cancer at some point is 1 in 8. That risk varies greatly throughout a woman’s lifetime, starting at 1 in several million during her early to mid teens, down to 1 in 27 in the decade between ages 70 and 80.
The odds still sound pretty good, right? They are, for otherwise healthy women, with no family history of breast cancer.
But for women at elevated risk due to known genetic factors, the odds are much worse – as high as 80%, or 4 out of 5. These women, who carry mutant BRCA1 or BRCA2 genes, often opt for prophylactic mastectomies (witness actress Angelina Jolie). They also are advised, in many cases, to have an early hysterectomy, to help prevent ovarian cancer.
Now, according to ASCO’s new practice guidelines, released last month in the Journal of Clinical Oncology, many more women beyond those with the BRCA genes might want to consider preventive treatment with one of three different drugs: tamoxifen or raloxifene (Evista), for premenopausal women; or exemestane (Aromasin), for those past menopause.
Included in this new group are the following:
•Women diagnosed with atypical hyperplasia, a “pre-cancer” marked by breast cells behaving in an abnormal manner. AH is typically diagnosed when a mammogram shows a suspicious area whose pathology turns out to be non-cancerous, but also atypical;
•Women diagnosed with lobular carcinoma in situ (LCIS);
•Childless postmenopausal women (women who’ve never given birth) with a family history of breast cancer (mother, daughter, sister).
About 2 million American women fall into one of the sub-groups above, and would be directly affected by ASCO’s new guidelines.
If you meet the guidelines above, and are at least 35 years old, you should consider taking a 5-year course of one of these drugs as a way to lower your breast cancer risk. And, heads up: you’ll probably have to be the one to initiate the discussion with your doctor.
So, why is it up to you to ask your GP about breast cancer prevention? Shouldn’t it come up in the course of your yearly physical, just like discussions about diabetes and high cholesterol?
Unfortunately, patient awareness is a major issue in breast health, authors of the new guidelines say. They note that cancer prevention is left in the hands of oncologists, while it should really be the responsibility of general practitioners. (Mulcahy, 2013)
According to Kathy Miller, M.D., an oncologist at Indiana University, “…primary care physicians simply don’t think this is their job. They don’t feel equipped and well trained… In their minds, the benefits of a SERM or an AI for prevention are too small to justify prescribing it.”
Miller went on to add, however, that drugs used to prevent breast cancer show the same level of effectiveness as the cholesterol-lowering statin drugs taken by millions of Americans to prevent heart attack and stroke. (Mulcahy, 2013)
Even if you think you’re a candidate for breast cancer prevention drugs, you may not be. Certain other health conditions (pregnancy or planned pregnancy; a history of stroke or deep-vein thrombosis, among others) make tamoxifen et. al. not a good choice.
Still, if you meet ASCO’s new guidelines, be sure to discuss breast cancer with your GP. S/he may not feel qualified to judge how well chemopreventive drugs might work for you; but s/he should at least be able to point you towards an oncologist or another physician who can help.
Doheny, K. (2013, July 09). Women at high breast cancer risk should consider preventive drugs: Experts. Retrieved from http://www.medicinenet.com/script/main/art.asp?articlekey=171169
Mulcahy, N. (2013, July 08). ASCO adds oomph to breast cancer chemoprevention guide. Retrieved from http://www.medscape.com/viewarticle/807489