USPSTF updates recommendations on risk-reducing breast cancer medications

Healthcare providers should offer risk-reducing medications such as tamoxifen, raloxifene and aromatase inhibitors to women at an increased risk of breast cancer or low risk of experiencing adverse effects, according to the U.S. Preventive Services Task Force (USPSTF). The full recommendation statement was published by JAMA.

“The USPSTF concludes with moderate certainty that there is a moderate net benefit from taking tamoxifen, raloxifene, or aromatase inhibitors to reduce risk of invasive breast cancer in women at increased risk,” according to the statement.

This plan of action is given a “B” recommendation. According to the USPSTF website, this means “there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.”

The USPSTF also announced that it recommends against “the routine use” of risk-reducing medications in women who are not at an increased risk of breast cancer. This plan of action received a “D” recommendation, meaning “there is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.”

All recommendations were designed for asymptomatic women who are at least 35 years old, the USPSTF emphasized in its statement. The group also highlighted the importance of this policy discussion, pointing to the fact that that breast cancer is the second leading cause of cancer death in the United States.

In addition, while the USPSTF referenced “convincing evidence” that tamoxifen and raloxifene are only associated with small to moderate harms, it found “adequate evidence” that the same was true for aromatase inhibitors.

A draft version of these recommendations were first shared with the public on Jan. 15.  

“In response to comments received, the USPSTF has clarified that the recommendation statement does not list every scenario in which medications could be considered but rather provides information on risk factors that clinicians could consider in assessing breast cancer risk with their patients,” according to the statement. “Some examples are provided to help clinicians understand how to consider these risk factors, but these examples should not be interpreted as a definitive list.”

These guidelines are consisted with what the USPSTF recommended back in 2013, according to the statement, though aromatase inhibitors have bow been added to the list of risk-reducing medications.

More information on how the USPSTF reached its conclusions and a patient-friendly summary of these recommendations are both available on the JAMA website.