Both USPSTF and ASCO have released guidance on the use of medications to reduce breast cancer risk in women who meet a certain risk threshold. The USPSTF guidance is in alignment with ASCO in the recommendation of aromatase inhibitors, along with tamoxifen and raloxifene, as drugs suitable for use as risk-reducing medications for women at increased risk for breast cancer and at low risk for adverse medication effect (USPSTF Grade B – offer or provide this service). Based on data review, the USPSTF and ASCO determined that certain medications have the potential to reduce the risk of estrogen receptor positive breast cancer by almost 50% in women. An individualized approach which integrates personal and family medical history is used to determine the best risk reduction approach.
Age 65 years or older with 1 first-degree relative with breast cancer
45 years or older with more than 1 first-degree relative with breast cancer or 1 first-degree relative who developed breast cancer before age 50 years
40 years or older with a first-degree relative with bilateral breast cancer
Presence of atypical ductal or lobular hyperplasia or lobular carcinoma in situ on a prior biopsy.
Tamoxifen, raloxifene, and aromatase inhibitors all reduce primary breast cancer risk in postmenopausal women
Use of raloxifene and aromatase inhibitors is indicated only in postmenopausal women
Only tamoxifen is indicated for risk-reduction of primary breast cancer in premenopausal women
USPSTF: Breast Cancer Medications for Risk Reduction
ASCO: Use of Endocrine Therapy for Breast Cancer Risk Reduction
NIH Breast Cancer Risk Assessment Tool (Gail)
Breast Cancer Surveillance Consortium Risk Calculator
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