USPSTF Adds Aromatase Inhibitors to Recommended Drugs for Cutting Breast Cancer Risk

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

Women at increased risk for breast cancer should be offered risk-reducing medications provided that their risk for adverse treatment effects is low, according to a new draft recommendation statement from the U.S. Preventive Services Task Force. The grade B recommendation is consistent with the group's 2013 guidance — but adds aromatase inhibitors (e.g., exemestane and anastrozole) to tamoxifen and raloxifene as potential treatment options.

While there is no set cutoff for defining "increased risk," the task force says, women with at least a 3% risk for breast cancer within the next 5 years are likely to benefit from treatment.

The National Cancer Institute's risk calculator can be used to assess a woman's risk (see fourth link below). Additionally, women with a combination of risk factors — for example, age 65 and older plus a first-degree relative with breast cancer — are also considered at increased risk.

Asked to comment, Dr. Andrew Kaunitz of NEJM Journal Watch Women's Health noted: "Although tamoxifen, raloxifene, and aromatase inhibitors have been shown to reduce the incidence of breast cancer in high-risk women, tamoxifen and raloxifene can cause hot flashes, and tamoxifen increases the risk for endometrial polyps and cancer. Aromatase inhibitors can cause hot flashes as well as arthralgias. Unfortunately, the occurrence of these side effects discourages use of these important chemoprophylactic agents in high-risk women."