Table 2 Summary of the high-risk women eligible for chemoprevention and the risks and benefits of selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs) for primary prevention
From: How do we increase uptake of tamoxifen and other anti-estrogens for breast cancer prevention?
Patient population for chemoprevention | Benefits of chemoprevention | Risks of chemoprevention |
|---|---|---|
Eligible women: | Selective estrogen receptor modulators: | Selective estrogen receptor modulators: |
• Age ≥ 60 years | • 30–50% relative risk reduction in breast cancer incidence | • Vasomotor symptoms, vaginal symptoms, leg cramps |
• Five-year risk of invasive breast cancer ≥ 1.67% according to the Gail model | • 33% relative risk reduction in fractures | • Increased risk of cataracts (tamoxifen) |
• Ten-year risk of breast cancer ≥ 5% according to the Tyrer-Cuzick model | • Only effective against estrogen receptor-positive breast cancer | • Increased risk of uterine cancer (tamoxifen) |
• Not associated with an overall survival benefit | • Increased risk of thromboembolism | |
High-risk women with a favorable risk/benefit profile from chemoprevention: | Aromatase inhibitors: | Aromatase inhibitors: |
• Age < 50 years | • 50–65% relative risk reduction in breast cancer incidence | • Vasomotor symptoms, vaginal dryness, arthralgias |
• Prior hysterectomy | • Only effective against estrogen receptor-positive breast cancer | • Increased risk of osteoporosis |
• Atypical hyperplasia or lobular carcinoma in situ | • Not associated with an overall survival benefit | • Increased risk of hyperlipidemia and hypertension |
• BRCA2 mutation carriers |
