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New study data identify women most likely to benefit from tamoxifen as primary prevention of breast cancer

Women age 40-50 years with at least a 3.4-percent five-year risk for breast cancer are most likely to benefit from tamoxifen as primary prevention therapy, according to an article in the September issue of Obstetrics & Gynecology. The same study concluded that therapy is not cost-effective for women age 60-65 years unless they have a very high five-year risk (greater than 5 percent).

Tamoxifen is the only drug approved in the USA for primary prevention of breast cancer in women. However, there has been debate over which women would most benefit from therapy based on side effects including risk for deep vein thrombosis, pulmonary embolism, stroke, and endometrial cancer.

In the current study, researchers examined data from an earlier report that noted more than 10 million US women are candidates for tamoxifen and at least 2 million of them would experience a net benefit from the drug.

The authors drew five major points from analysis. First, tamoxifen is cost-effective for every woman between the ages of 40-50 years who has at least a 3.4% five-year risk of breast cancer. In addition, tamoxifen may be justified in 40-year-old women who have a baseline five-year risk as low as 1.5 percent.

The researchers also drew conclusions on usage in older women. For women age 60-65 years, tamoxifen would only be cost-effective if the five-year risk of breast cancer is very high (more than 5 percent). For women age 51-59 years, tamoxifen treatment decisions need to be individualized according to actual age, whether or not a woman has had a hysterectomy, and whether their five-year risk of breast cancer is at least 3.5-4 percent.

Tamoxifen is not appropriate for women with a high risk of cerebral vascular disease (such as known atherosclerosis or strong family history of stroke) or a hypercoagulable state.

Physicians can quickly calculate a woman's five-year risk of breast cancer by using the Gail Model, a formula that incorporates current age, age at menarche, age at birth of first child, race, breast biopsy history, and family history of breast cancer. The electronic version of The Gail Model is available through the National Cancer Institute at http://cancer.gov/bcrisktool.

 



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