A Pill a Day to Keep Breast Cancer Away
Medscape: In the treatment setting, tamoxifen is recommended to be taken for at least 10 years in some women. Is there evidence that it can be taken safely for 10 years?
Dr. Visvanathan: That's a good question. We now have data showing that if you take tamoxifen for 5 years you continue to have benefit; vascular side effects, which can be serious, drop off once you stop taking it. I think both of those points are important. We don't have any data that longer is better; at this point it is really 5 years. The other point to make about tamoxifen is that from longer-term analysis, it does seem to be more effective than raloxifene. That does not negate raloxifene, however, because it was still beneficial and had a better side-effect profile.
Medscape: Can raloxifene be used in groups of patients who cannot tolerate tamoxifen? Doesn't it have less of a thrombotic effect?
Dr. Visvanathan: Raloxifene has less of a thrombotic effect. In a woman who has osteoporosis or low bone density, one might opt more for raloxifene than tamoxifen because you would be addressing both concerns.
Medscape: There is a new recommendation in the guideline for an aromatase inhibitor, exemestane, which is not yet approved by the FDA for breast cancer prevention.
Dr. Visvanathan: The basis for that recommendation is one study, MAP.3, and the only caveat there is that we do not have long-term follow-up. Recently, Cuzick and colleagues published the results of a randomized trial (IBIS-II) looking at anastrozole, for chemoprevention, and the favorable results indicate that anastrozole provides women with another option.
Medscape: Does ASCO plan to put out separate guidelines on other aspects of prevention, such as lifestyle recommendations?
Dr. Visvanathan: Good question. They are aware that it is an important topic. I cannot comment on whether they are planning a guideline.
Medscape: What is the strongest reason for PCPs to discuss chemoprevention of breast cancer with their patients?
Dr. Visvanathan: Because for some women, these therapies can reduce the risk for breast cancer by up to 50%.
Evidence Suggests Tamoxifen Better Than Raloxifene
Medscape: In the treatment setting, tamoxifen is recommended to be taken for at least 10 years in some women. Is there evidence that it can be taken safely for 10 years?
Dr. Visvanathan: That's a good question. We now have data showing that if you take tamoxifen for 5 years you continue to have benefit; vascular side effects, which can be serious, drop off once you stop taking it. I think both of those points are important. We don't have any data that longer is better; at this point it is really 5 years. The other point to make about tamoxifen is that from longer-term analysis, it does seem to be more effective than raloxifene. That does not negate raloxifene, however, because it was still beneficial and had a better side-effect profile.
Medscape: Can raloxifene be used in groups of patients who cannot tolerate tamoxifen? Doesn't it have less of a thrombotic effect?
Dr. Visvanathan: Raloxifene has less of a thrombotic effect. In a woman who has osteoporosis or low bone density, one might opt more for raloxifene than tamoxifen because you would be addressing both concerns.
Medscape: There is a new recommendation in the guideline for an aromatase inhibitor, exemestane, which is not yet approved by the FDA for breast cancer prevention.
Dr. Visvanathan: The basis for that recommendation is one study, MAP.3, and the only caveat there is that we do not have long-term follow-up. Recently, Cuzick and colleagues published the results of a randomized trial (IBIS-II) looking at anastrozole, for chemoprevention, and the favorable results indicate that anastrozole provides women with another option.
Medscape: Does ASCO plan to put out separate guidelines on other aspects of prevention, such as lifestyle recommendations?
Dr. Visvanathan: Good question. They are aware that it is an important topic. I cannot comment on whether they are planning a guideline.
Medscape: What is the strongest reason for PCPs to discuss chemoprevention of breast cancer with their patients?
Dr. Visvanathan: Because for some women, these therapies can reduce the risk for breast cancer by up to 50%.
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