The American Society of Clinical Oncology took a major step towards making progress in preventing breast cancer and updated their 2009 guidelines. The updates include recommendations that tamoxifen and raloxifene (Evista) “should” be discussed as options to reduce risk of invasive, ER-positive breast cancer in pre- and post-menopausal women at higher than usual risk of the disease, instead of simply “may be discussed.” Support for these stronger guidelines comes from “strong evidence-based research,” published since 2009, yet only 1 percent of women who may benefit from “chemoprevention” measures are taking these drugs.
The biggest change, however, is that now the society is recommending that physicians also discuss the use of the aromatase inhibitor exemestane (Aromasin) as an option to prevent breast cancer in postmenopausal women. This new recommendation is based on a clinical trial that found that over a three-year period, exemestane reduced the overall risk of breast cancer and ER-positive breast cancer by up to 70 percent, compared to a placebo.
This is really not so new. Breast cancer specialists been talking about using aromatase inhibitors as a method of chemoprevention for years. But this is a very important recommendation for high-risk women. In fact, my organization, ACSH.org, has been touting the benefits of chemoprevention for over a decade.
Dr. Stuart Lippman of the University of California, San Diego, chair of the ASCO panel, says though that “the most important element is the discussion of risk and benefits between the doctor and patients.”