Are Breast Cancer Risk-Reducing Medications Right For You?
With the exception of skin cancer, breast cancer is the most common cancer among American women, and the second leading cause of cancer deaths in the US. Women with a high risk of developing breast cancer have the option of lowering their risk by taking certain medications.
The US Preventive Services Task Force (USPSTF) recently made two updates to their recommendations for risk-reduction medications:
“The USPSTF recommends that clinicians offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects”. This recommendation is for women who have never been diagnosed with breast cancer, but have at least a 3% risk of developing the disease within 5 years.
“The USPSTF recommends against the routine use of risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, in women who are not at increased risk for breast cancer… This recommendation applies to asymptomatic women 35 years and older, including women with previous benign breast lesions on biopsy such as atypical ductal hyperplasia or lobular hyperplasia, and LCIS. This recommendation does not apply to women who have a current or previous diagnosis of breast cancer or ductal carcinoma in situ.” In this group of patients, the side effects associated with taking these medications would likely outweigh the prevention benefit.
The USPSTF based its recommendations on the evidence of the benefits and potential side effects of taking any of these risk-reducing medications, and an assessment of the balance. The USPSTF does not consider the cost of care in any of their assessments.
The USPSTF also states that it recognizes that clinical decisions involve more considerations than evidence alone. We strongly encourage a shared decision-making approach between patients and their healthcare team to determine what’s best for you. If you would like to learn if you could benefit from taking a risk-reducing medication and whether taking one is right for you, please discuss the full range of options, risks and benefits with your physician.
You can read the full USPSTF statement here.
USPSTF Expands BRCA Gene Testing But Not Far Enough
The US Preventive Services Task Force (USPSTF) issued a new recommendation statement calling for more patients to receive genetic counseling and genetic testing for BRCA1 and BRCA2 gene mutations.
Often referred to as the “breast cancer gene,” mutations in BRCA1 and BRCA2 genes have been shown to increase the likelihood of an individual developing breast, ovarian, fallopian tube and peritoneal cancer.
To better predict and manage the risk of developing hereditary cancers, the USPSTF is now recommending more patients, including breast, ovarian, fallopian tube and peritoneal cancer survivors, undergo genetic counseling and genetic testing. Previously, the USPSTF only recommended those who had a family history BRCA-related cancers be tested.
The USPSTF statement, published in the JAMA Network, recommends that “primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with BRCA1/2 gene mutations with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing… The USPSTF recommends against routine risk assessment, genetic counseling, or genetic testing for women whose personal or family history or ancestry is not associated with potentially harmful BRCA1/2 gene mutations.”
Why are these tests important? Expanding testing will potentially help survivors determine which treatments would be best based on their current diagnosis, as well as alert them to treatments that could significantly lower their future cancer risk, such as risk-reducing mastectomy and hysterectomy. It could also be very important and possibly life-saving for some of the survivors’ family members.
While the updated recommendations are very good news, in several ways they do not go far enough: newly diagnosed patients with breast or ovarian cancer, patients with advanced cancers, and men were not included. Men who carry a BRCA gene mutation are at increased risk for breast, pancreatic and prostate cancers, and should also have counseling and testing. As in women, these mutations can be passed on to their children and beyond.
Anyone who is concerned about their future cancer risk and doesn’t fall into these guidelines should consider proactively seeking a consultation with a genetic counselor. You can find a certified genetic counselor near you via the National Society of Genetic Counselors.
