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Clinical Summary

Breast Cancer: Medications for Risk Reduction

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Clinical Summary of U.S. Preventive Services Task Force Recommendation

Population Asymptomatic women aged ≥35 years without a prior diagnosis of breast cancer who are at increased risk for the disease Asymptomatic women aged ≥35 years without a prior diagnosis of breast cancer who are not at increased risk for the disease
Recommendation Engage in shared, informed decision making and offer to prescribe risk-reducing medications, if appropriate.
Grade: B
Do not prescribe risk-reducing medications.
Grade: D
Risk Assessment Important risk factors for breast cancer include patient age, race/ethnicity, age at menarche, age at first live childbirth, personal history of ductal or lobular carcinoma in situ, number of first-degree relatives with breast cancer, personal history of breast biopsy, body mass index, menopause status or age, breast density, estrogen and progestin use, smoking, alcohol use, physical activity, and diet.

Available risk assessment models can accurately predict the number of breast cancer cases that may arise in certain study populations, but their ability to accurately predict which women will develop breast cancer is modest.

Preventive Medications The selective estrogen receptor modulators tamoxifen and raloxifene have been shown to reduce the incidence of invasive breast cancer in postmenopausal women who are at increased risk for the disease. The usual daily doses for tamoxifen and raloxifene are 20 mg and 60 mg, respectively, for 5 years.
Balance of Benefits and Harms There is a moderate net benefit from use of tamoxifen and raloxifene to reduce the incidence of invasive breast cancer in women who are at increased risk for the disease. The potential harms of tamoxifen and raloxifene outweigh the potential benefits for breast cancer risk reduction in women who are not at increased risk for the disease.

Potential harms include thromboembolic events, endometrial cancer, and cataracts.

Other Relevant USPSTF Recommendations The USPSTF has made recommendations on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer, as well as screening for breast cancer. These recommendations are available at http://www.uspreventiveservicestaskforce.org.

For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement, and supporting documents, please go to http://www.uspreventiveservicestaskforce.org.

Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

Current as of: October 2013

Internet Citation: Clinical Summary: Breast Cancer: Medications for Risk Reduction. U.S. Preventive Services Task Force. October 2014.
https://www.uspreventiveservicestaskforce.org/Page/Document/ClinicalSummaryFinal/breast-cancer-medications-for-risk-reduction

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