USPSTF Releases Draft Recommendation on Drugs to Lower Risk of Breast Cancer

Earlier this week, the US Preventive Services Task Force released a draft guidance recommendation on medications for women at an increased risk for breast cancer.

Based on its review of the evidence, the Task Force recommended that clinicians offer to prescribe risk-reducing mediations, such as chemoprevention drugs tamoxifen and raloxifene, to women who are at an increased risk for breast cancer and at a low risk for adverse effects. The recommendation was largely a reaffirmation of the final guidance issued by the Task Force in 2013, with the addition of aromatase inhibitors as “medication for clinical consideration.” This is notable, however, because the FDA has not approved aromatase inhibitors as a chemoprevention product for breast cancer.

“Too many American women and families are faced with the challenge of dealing with a breast cancer diagnosis. Women who are at increased risk for breast cancer should be offered medications that can help reduce that risk,” said Task Force member Michael Barry, MD, in a statement.

The recommendation was based on data from a systematic review that found that, compared with placebo, tamoxifen reduced the incidence of invasive breast cancer by 7 events per 1000 women over 5 years, raloxifene reduced the incidence by 9 events per 1000 women over 5 years, and aromatase inhibitors reduced the incidence by 16 events per 1000 women over 5 years.

The Task Force also emphasized that although the data show that these medications can reduce a women’s risk of developing invasive breast cancer, the medications can also lead to “serious harms.” Importantly, the recommendations are not for women who have a current or previous cancer diagnosis.

“When deciding whether or not to offer mediations, clinicians should carefully consider their patients’ risk factors for breast cancer and balance these against the potential harms from the medications,” said Carol Mangione, MD, MSPH, Task Force member, in a statement. “These medications are not for everyone, and for women who are not at an increased risk of breast cancer, the harms of these medications are likely to outweigh the benefits.”

The Task Force is taking comments on the draft recommendation until February 11, 2019.