Breast Cancer Screening Guidelines
- Most guidelines recommend annual mammograms for women starting at age 40. The U.S. Preventive Services Task Force recommends that women at average risk for breast cancer have mammograms once every 2 years beginning at age 50.
- Women at high risk for breast cancer because of BRCA mutations, family history, or other factors, should have an MRI along with a mammogram every year.
Hormone Therapy Guidelines
In 2010, the American Society of Clinical Oncology (ASCO) updated its clinical guidelines for treatment of hormone-sensitive breast cancer. ASCO recommends:
- Postmenopausal women with hormone-sensitive breast cancer should take an aromatase inhibitor drug for up to 5 years as adjuvant (after surgery) endocrine therapy. The three aromatase inhibitor drugs are anastrazole (Armidex, generic), exemestane (Aromasin), and letrozole (Femara). They all work equally well.
- Premenopausal and perimenopausal women with hormone-sensitive breast cancers should take tamoxifen for up to 5 years. Women who have reached menopause can switch to an aromatase inhibitor after 2 - 3 years of tamoxifen therapy to complete the 5-year treatment. Postmenopausal women who have already completed 5 years of tamoxifen therapy can take an aromatase inhibitor drug for up to another 5 years to further reduce the risk of breast cancer recurrence.
- Tamoxifen and aromatase inhibitors have side effects. Tamoxifen increases the risk for blood clots and endometrial cancer. Aromatase inhibitors increase the risk for osteoporosis. Both types of drugs can cause hot flashes.
FDA Reconsiders Bevacizumab (Avastin)
In 2010, the Food and Drug Administration (FDA) announced it was considering revoking bevacizumab’s (Avastin) approval for treatment of metastatic breast cancer. The FDA cited data indicating that the drug does not significantly improve survival time and that its risks may outweigh its benefits. A final decision on bevacizumab was expected to be made by the end of the year.
Review Date: 11/08/2010
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.