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Tamoxifen for breast cancer prevention does not benefit most women

Most women at high risk for breast cancer do not increase their life expectancy by taking the drug tamoxifen, according to a new analysis by researchers from UC Davis, UCSF, the University of Pittsburgh and McMaster University in Ontario, Canada. In addition, the researchers showed that tamoxifen is an extraordinarily expensive cancer-prevention strategy, costing as much as $1.3 million per year of life saved. The study will be published in the Sept. 1 issue of the American Cancer Society's journal Cancer, and appear online on Monday.

"We found that for women at the lower end of the high-risk range for developing breast cancer, there is a very small likelihood that taking tamoxifen will reduce mortality," said Joy Melnikow, professor of family and community medicine at UC Davis School of Medicine and Medical Center and lead author of the study. "This would support revising the current recommended risk threshold for physicians to counsel women about tamoxifen."

Tamoxifen was approved by the U.S. Food and Drug Administration in 1998 for breast cancer prevention in women who have at least a 1.67-percent chance of developing the disease over the next five years. Such women are considered at high risk for breast cancer. Groups such as the U.S. Preventive Services Task Force and the Canadian Task Force on Preventive Health Care recommend that physicians counsel women above this threshold about the benefits and risks of tamoxifen as a means of preventing the disease.

Tamoxifen is a selective estrogen receptor-modulating drug used to treat estrogen receptor-positive breast cancers. In addition, it has been shown to reduce the incidence of invasive breast cancer among high-risk women by up to 49 percent.

However, tamoxifen is associated with significant adverse effects, including cataracts requiring surgery, deep vein thromboses, endometrial cancer and stroke. Women taking tamoxifen, if they do develop breast cancer, are also more likely to
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Source:University of California - Davis


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