The People's Perspective on Medicine

Should You Take a Drug to Prevent Breast Cancer?

The USPSTF says a woman at high risk can benefit from taking a drug to prevent breast cancer. A woman whose risk is low will probably benefit very little.
Young arab doctor woman with curly hair holding cancer ribbon over isolated pink background with open hand doing stop sign with serious and confident expression, defense gesture

Should doctors be prescribing a drug to prevent breast cancer? The US Preventive Services Task Force (USPSTF) suggests that women at high risk of the disease would probably benefit from anti-estrogen medicines (JAMA, Sept 3, 2019). These include medicines like tamoxifen, raloxifene and aromatase inhibitors such as anastrozole (Arimidex), exemestane (Aromasin) or letrozole (Femara). The committee recommends a drug to prevent breast cancer only for women at relatively low risk for side effects, however.

Who Might Not Benefit from a Drug to Prevent Breast Cancer? 

Women who don’t have an increased risk of breast cancer might experience more harm than help as a result of taking such anti-estrogen medicines. Tamoxifen and raloxifene can trigger dangerous blood clots, and tamoxifen also increases a woman’s chance of endometrial cancer. In addition, tamoxifen may make cataracts more likely. Unfortunately, these risks are higher for older women, who are also likely to be at increased risk for breast cancer.

The aromatase inhibitors keep body tissues from making estrogen, which can fuel many forms of breast cancer. They, too, have potential side effects. These include hot flashes, digestive distress, muscle and joint pain and cardiovascular complications such as stroke. Unlike tamoxifen and raloxifene, which tend to prevent bone fractures, aromatase inhibitors may increase a woman’s susceptibility. Nonetheless, for a woman at high risk of breast cancer, such a drug to prevent breast cancer might be worthwhile. Drugs like Arimidex and Aromasin are approved for breast cancer treatment; the FDA has not approved them for prevention.

How the USPSTF Reached Its Conclusions:

The task force notes that the methods for assessing population-level risk of developing cancer are pretty good. However, they do not allow doctors to tell which women will and which women won’t eventually get this diagnosis. That makes it much harder to determine who will benefit most from the preventive prescription.

As a result, each woman needs to confer with her doctor regarding her risk of breast cancer and her potential for adverse reactions. That way, they can decide together if she should take a drug to prevent breast cancer.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Citations
  • US Preventive Services Task Force, "Medication Use to Reduce Risk of Breast Cancer." JAMA, Sept 3, 2019. doi:10.1001/jama.2019.11885
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I’m taking exemestane (Aromasin) due to an estrogen-positive breast cancer tumor found in March 2007. I have been diagnosed with severe arthritis in my upper, middle and lower thoracic vertebra. I am assuming that this is due to the medication.
Most recently, I’m noticing some neuropathy in my toes. Is this also a side effect of the exemestane? Anyone else have neuropathy?
Thanks!

I have been taking Arimidex in a generic form for almost two years. The side effects are brutal. I will see my doctor soon and discuss with her about stopping them. I am a young 72, and I have had to stop many of the things that I enjoyed before breast cancer and Arimidex because of the muscle and joint pain.

I have been diagnosed with ductile carcinoma in situ or DCIS. After a lumpectomy I am being encouraged to take aromatace inhibitors (I am 62). My mother, and a friend with invasive ductile cancer both had cancer recurrence while on or shortly after stopping. They both also experienced hot flashes and joint pain which did not go away when they stopped taking the drug. I have opted not to take the aromatace inhibitors. Now my oncologist is sending me to a radiation oncologist for a consult. I feel they are over-treating an age-related cancer.

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