USPSTF Draft Recommendation

Women at Risk for Breast Cancer Should Participate in Decisions About Risk-reducing Drugs

April 16, 2013 03:30 pm Matt Brown

According to a draft recommendation(www.uspreventiveservicestaskforce.org) recently introduced by the U.S. Preventive Services Task Force (USPSTF), physicians should strive to engage women at increased risk of breast cancer in the process of making decisions about medications that can reduce their risk. At-risk women who are deemed to be at low risk for adverse effects from these drugs could benefit from taking medications such as tamoxifen or raloxifene.

This illustration shows a three-dimensional model of the tamoxifen molecule in its solid state.

In addition, when gauging cancer risk, the recommendation statement notes that if a physician uncovers a family history of breast cancer or a personal history of breast biopsy during the patient history, he or she may want to consider using a breast cancer risk assessment tool to elicit more definitive information.

"This recommendation is for women ages 40 to 70, and it's not about screening for BRCA (breast cancer susceptibility genes), but (screening for) anything that puts a woman at high risk for breast cancer, including family history of breast cancer, a previous biopsy that showed some kind of atypical cell development, and other factors," said family physician and USPSTF member Mark Ebell, M.D., of Athens, Ga.

story highlights

  • The U.S. Preventive Services Task Force has issued a draft statement recommending that physicians engage women at increased risk of breast cancer in shared decision-making about medications that can reduce their risk.
  • For at-risk women who are deemed to be at low risk for drug adverse effects, family physicians are encouraged to offer to prescribe medications such as tamoxifen or raloxifene.
  • The task force recommends against the routine use of such medications in women who are not at increased risk for breast cancer.

"We are encouraging women to think about whether they might be at an increased or higher-than-average risk of breast cancer," Ebell said. "As family physicians, we need to be prepared to have those discussions with our patients, and that means being familiar with risk assessment tools."

Ebell, who also serves as deputy editor of American Family Physician, said the recommendation lists several assessment tools family physicians and other health care professionals could use to grade a woman's risk. He singled out the National Cancer Institute's Breast Cancer Risk Assessment Tool(www.cancer.gov), which estimates the five-year incidence of invasive breast cancer among women based on certain characteristics, as one such tool that works particularly well in a primary care setting.

"It's a simple interactive calculator that women can go through either before they see their physician or while they're in the office," Ebell said. "It just takes a couple of minutes and gives you a good risk estimate. And I think it is important for us, as family physicians, to be aware that a lot of women feel they are at increased risk and will want to look at (that possibility).

"So I feel it is important to do this in a formal setting to let them know they may not be at as high a risk as originally thought."

The draft recommendation does not apply to women who have a history of blood clots, including those who have or have had deep vein thrombosis, pulmonary emboli, strokes or transient ischemic attacks.

Ebell also said the task force recommends against routinely using risk-reducing medications in women who are not at an increased risk for breast cancer. "These medications have potential benefits in terms of reducing breast cancer and fracture, but they also have some serious potential harms in terms of causing clots, endometrial cancer and possibly stroke," he said. "So you want to make sure that the benefit outweighs the harms, and we provide some tables that should help family physicians look at that for each individual woman and help them make a more informed decision."

The draft recommendation statement is available for comment until May 13 at 5 p.m. EDT.

The AAFP Commission on Health of the Public and Science is reviewing the USPSTF draft recommendation and evidence report and will comment on the draft statement and make recommendations to the Academy's Board of Directors regarding any indicated changes in current AAFP policy (scroll down to "Breast Cancer, Prevention Medication").


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