Virginia A. Moyer, MD, MPH; on behalf of the U.S. Preventive Services Task Force (*)
Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Financial Support: The USPSTF is an independent, voluntary body. The U.S. Congress mandates that the Agency for Healthcare Research and Quality support the operations of the USPSTF.
Potential Conflicts of Interest: Disclosure forms from USPSTF members can be viewed at www.acponline.org/authors/icmje/ConflictOf InterestForms.do?msNum=M13-1993.
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Update of the 2002 U.S. Preventive Services Task Force (USPSTF) recommendation on the use of medications for breast cancer risk reduction.
The USPSTF reviewed evidence on the effectiveness, adverse effects, and subgroup variations of medications to reduce the risk for breast cancer—specifically, the selective estrogen receptor modulators tamoxifen and raloxifene. The USPSTF also reviewed a meta-analysis of placebo-controlled trials to understand the relative benefits and harms of tamoxifen and raloxifene.
This recommendation applies to asymptomatic women aged 35 years or older without a prior diagnosis of breast cancer, ductal carcinoma in situ, or lobular carcinoma in situ.
The USPSTF recommends that clinicians engage in shared, informed decision making with women who are at increased risk for breast cancer about medications to reduce their risk. For women who are at increased risk for breast cancer and at low risk for adverse medication effects, clinicians should offer to prescribe risk-reducing medications, such as tamoxifen or raloxifene. (B recommendation)
The USPSTF recommends against the routine use of medications, such as tamoxifen or raloxifene, for risk reduction of primary breast cancer in women who are not at increased risk for breast cancer. (D recommendation)
Medications for risk reduction of primary breast cancer in women: clinical summary of U.S. Preventive Services Task Force recommendation.
Appendix Table 1. What the USPSTF Grades Mean and Suggestions for Practice
Appendix Table 2. USPSTF Levels of Certainty Regarding Net Benefit
Appendix Table 3. Summary of Primary Prevention Trials*
Benefit–risk indices for tamoxifen and raloxifene chemoprevention in white non-Hispanic women with a uterus, by age group and level of 5-y projected risk for invasive breast cancer.
Reproduced from Freedman and colleagues (8) with permission from the American Society of Clinical Oncology. This figure remains the property of the American Society of Clinical Oncology and is not part of the public domain. BCPT = Breast Cancer Prevention Trial; IBC = invasive breast cancer; RR = relative risk; STAR = Study of Tamoxifen and Raloxifene; WHI = Women's Health Initiative.
Benefit–risk indices for tamoxifen and raloxifene chemoprevention in black women with a uterus, by age group and level of 5-y projected risk for invasive breast cancer.
Benefit–risk indices for tamoxifen and raloxifene chemoprevention in white non-Hispanic women without a uterus, by age group and level of 5-y projected risk for invasive breast cancer.
Benefit–risk indices for tamoxifen and raloxifene chemoprevention in black women without a uterus, by age group and level of 5-y projected risk for invasive breast cancer.
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Moyer VA, on behalf of the U.S. Preventive Services Task Force. Medications for Risk Reduction of Primary Breast Cancer in Women: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2013;159:698–708. doi: 10.7326/0003-4819-159-10-201311190-00718
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Published: Ann Intern Med. 2013;159(10):698-708.
Breast Cancer, Cancer Screening/Prevention, Guidelines, Hematology/Oncology, Prevention/Screening.
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