These data do not change what we already know: Chemoprevention is slam-dunk, hands-down effective in preventing breast cancer. The effects of 5 years of chemoprevention persist for 20 years. This is great because it [could potentially] reduce the numbers of women we need to treat,” said Erin Hofstatter, MD, Assistant Professor and Co-Director of the Cancer Genetics and Prevention Program at Yale University School of Medicine.
“Will these results impact care and improve the uptake of chemoprevention among high-risk women? Sadly, I don’t think it will change women’s minds. Many women at high risk don’t want to take a medication once they hear about the side effects. We need better ways to identify [women who truly are at high risk] and inform women about their real risk. Then they might decide to take chemoprevention,” she continued.
In her practice, Dr. Hofstatter counsels women to try chemoprevention and says that they can stop it if they have unacceptable side effects. “I [also] think we need to study approaches outside of tamoxifen and aromatase inhibitors. Some people are studying the effects of natural substances, such as omega 3 fatty acids. That would be acceptable to most women, [and could have a real effect on breast cancer incidence if taken by a large population of women],” she said.
Dr. Hofstatter also offers postmenopausal women raloxifene, which has a better side-effect profile than tamoxifen and aromatase inhibitors and also protects their bones. “I’ve had much better [uptake rates] with raloxifene,” she said. She noted that tamoxifen also protects bones and said that if it were marketed that way, uptake might be better.
“Cardiologists do a much better job of primary prevention than breast oncologists. Just look at the uptake of [atorvastatin (Lipitor)], and that drug has side effects. The number needed to treat with [atorvastatin] to avoid one heart attack is in the 60s, which is much higher than the number needed to treat with tamoxifen,” she said. ■
Disclosure: Dr. Hofstatter reported no potential conflicts of interest.
