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Medication Use to Reduce Risk of Breast CancerUS Preventive Services Task Force Recommendation Statement

Educational Objective
To review the US Preventive Services Task Force (USPSTF) recommendations regarding the use of medications to reduce the risk of breast cancer.
1 Credit CME
Abstract

Importance  Breast cancer is the most common nonskin cancer among women in the United States and the second leading cause of cancer death. The median age at diagnosis is 62 years, and an estimated 1 in 8 women will develop breast cancer at some point in their lifetime. African American women are more likely to die of breast cancer compared with women of other races.

Objective  To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on medications for risk reduction of primary breast cancer.

Evidence Review  The USPSTF reviewed evidence on the accuracy of risk assessment methods to identify women who could benefit from risk-reducing medications for breast cancer, as well as evidence on the effectiveness, adverse effects, and subgroup variations of these medications. The USPSTF reviewed evidence from randomized trials, observational studies, and diagnostic accuracy studies of risk stratification models in women without preexisting breast cancer or ductal carcinoma in situ.

Findings  The USPSTF found convincing evidence that risk assessment tools can predict the number of cases of breast cancer expected to develop in a population. However, these risk assessment tools perform modestly at best in discriminating between individual women who will or will not develop breast cancer. The USPSTF found convincing evidence that risk-reducing medications (tamoxifen, raloxifene, or aromatase inhibitors) provide at least a moderate benefit in reducing risk for invasive estrogen receptor–positive breast cancer in postmenopausal women at increased risk for breast cancer. The USPSTF found that the benefits of taking tamoxifen, raloxifene, and aromatase inhibitors to reduce risk for breast cancer are no greater than small in women not at increased risk for the disease. The USPSTF found convincing evidence that tamoxifen and raloxifene and adequate evidence that aromatase inhibitors are associated with small to moderate harms. Overall, the USPSTF determined that the net benefit of taking medications to reduce risk of breast cancer is larger in women who have a greater risk for developing breast cancer.

Conclusions and Recommendation  The USPSTF recommends that clinicians offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects. (B recommendation) The USPSTF recommends against the routine use of risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, in women who are not at increased risk for breast cancer. (D recommendation) This recommendation applies to asymptomatic women 35 years and older, including women with previous benign breast lesions on biopsy (such as atypical ductal or lobular hyperplasia and lobular carcinoma in situ). This recommendation does not apply to women who have a current or previous diagnosis of breast cancer or ductal carcinoma in situ.

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Article Information

Corresponding Author: Douglas K. Owens, MD, MS, Stanford University, 616 Serra St, Encina Hall, Room C336, Stanford, CA 94305-6019 (chair@uspstf.net)

Accepted for Publication: July 29, 2019.

The US Preventive Services Task Force (USPSTF) members: Douglas K. Owens, MD, MS; Karina W. Davidson, PhD, MASc; Alex H. Krist, MD, MPH; Michael J. Barry, MD; Michael Cabana, MD, MA, MPH; Aaron B. Caughey, MD, PhD; Chyke A. Doubeni, MD, MPH; John W. Epling Jr, MD, MSEd; Martha Kubik, PhD, RN; C. Seth Landefeld, MD; Carol M. Mangione, MD, MSPH; Lori Pbert, PhD; Michael Silverstein, MD, MPH; Chien-Wen Tseng, MD, MPH, MSEE; John B. Wong, MD.

Affiliations of The US Preventive Services Task Force (USPSTF) members: Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Owens); Stanford University, Stanford, California (Owens); Feinstein Institute for Medical Research at Northwell Health, Manhasset, New York (Davidson); Fairfax Family Practice Residency, Fairfax, Virginia (Krist); Virginia Commonwealth University, Richmond (Krist); Harvard Medical School, Boston, Massachusetts (Barry); University of California, San Francisco (Cabana); Oregon Health & Science University, Portland (Caughey); Mayo Clinic, Rochester, New York (Doubeni); Virginia Tech Carilion School of Medicine, Roanoke (Epling Jr); Temple University, Philadelphia, Pennsylvania (Kubik); University of Alabama at Birmingham (Landefeld); University of California, Los Angeles (Mangione); University of Massachusetts Medical School, Worcester (Pbert); Boston University, Boston, Massachusetts (Silverstein); University of Hawaii, Honolulu (Tseng); Pacific Health Research and Education Institute, Honolulu, Hawaii (Tseng); Tufts University School of Medicine, Boston, Massachusetts (Wong).

Author Contributions: Dr Owens had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The USPSTF members contributed equally to the recommendation statement.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Authors followed the policy regarding conflicts of interest described at https://www.uspreventiveservicestaskforce.org/Page/Name/conflict-of-interest-disclosures. Dr Barry reported receiving grants and personal fees from Healthwise, a nonprofit, outside the submitted work. All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings.

Funding/Support: The USPSTF is an independent, voluntary body. The US Congress mandates that the Agency for Healthcare Research and Quality (AHRQ) support the operations of the USPSTF.

Role of the Funder/Sponsor: AHRQ staff assisted in the following: development and review of the research plan, commission of the systematic evidence review from an Evidence-based Practice Center, coordination of expert review and public comment of the draft evidence report and draft recommendation statement, and the writing and preparation of the final recommendation statement and its submission for publication. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication.

Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services.

Additional Contributions: We thank Tina Fan, MD, MPH (AHRQ), who contributed to the writing of the manuscript, and Corey Mackison (AHRQ), who assisted with coordination and editing.

References
1.
National Cancer Institute (NCI). SEER Cancer Stat Facts: Female Breast Cancer 2018. NCI website. https://seer.cancer.gov/statfacts/html/breast.html. Published 2018. Accessed August 1, 2019.
2.
American Cancer Society (ACS). Cancer Facts & Figures 2018. ACS website. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2018.html. Published 2018. Accessed August 1, 2019.
3.
Nelson  HD, Fu  R, Zakher  B,  et al.  Medication Use for the Risk Reduction of Primary Breast Cancer in Women: A Systematic Review for the U.S. Preventive Services Task Force. Rockville, MD: Agency for Healthcare Research and Quality; 2019.
4.
Nelson  HD, Fu  R, Zakher  B,  et al.  Medication use for the risk reduction of primary breast cancer in women: updated evidence report and systematic review for the US Preventive Services Task Force  [published September 3, 2019].  JAMA. doi:10.1001/jama.2019.5780Google Scholar
5.
National Cancer Institute (NCI). The Breast Cancer Risk Assessment Tool. NCI website. https://bcrisktool.cancer.gov/. 2017. Accessed November 23, 2018.
6.
Freedman  AN, Yu  B, Gail  MH,  et al.  Benefit/risk assessment for breast cancer chemoprevention with raloxifene or tamoxifen for women age 50 years or older.  J Clin Oncol. 2011;29(17):2327-2333. doi:10.1200/JCO.2010.33.0258PubMedGoogle ScholarCrossref
7.
Travis  LB, Hill  D, Dores  GM,  et al.  Cumulative absolute breast cancer risk for young women treated for Hodgkin lymphoma.  J Natl Cancer Inst. 2005;97(19):1428-1437. doi:10.1093/jnci/dji290PubMedGoogle ScholarCrossref
8.
Kuchenbaecker  KB, Hopper  JL, Barnes  DR,  et al; BRCA1 and BRCA2 Cohort Consortium.  Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers.  JAMA. 2017;317(23):2402-2416. doi:10.1001/jama.2017.7112PubMedGoogle ScholarCrossref
9.
American Cancer Society (ACS). Breast Cancer Facts & Figures 2017-2018. ACS website. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2017-2018.pdf. 2017. Accessed August 1, 2019.
10.
National Cancer Institute (NCI). BRCA Mutations: Cancer Risk and Genetic Testing. NCS website. https://www.cancer.gov/about-cancer/causes-prevention/genetics/brca-fact-sheet. 2018. Accessed November 16, 2018.
11.
Forbes  JF, Sestak  I, Howell  A,  et al; IBIS-II investigators.  Anastrozole versus tamoxifen for the prevention of locoregional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in situ (IBIS-II DCIS): a double-blind, randomised controlled trial.  Lancet. 2016;387(10021):866-873. doi:10.1016/S0140-6736(15)01129-0PubMedGoogle ScholarCrossref
12.
Goldvaser  H, Barnes  TA, Šeruga  B,  et al.  Toxicity of extended adjuvant therapy with aromatase inhibitors in early breast cancer: a systematic review and meta-analysis  [published online January 1, 2018].  J Natl Cancer Inst. doi:10.1093/jnci/djx141PubMedGoogle Scholar
13.
Cuzick  J, Forbes  JF, Sestak  I,  et al; International Breast Cancer Intervention Study I Investigators.  Long-term results of tamoxifen prophylaxis for breast cancer—96-month follow-up of the randomized IBIS-I trial.  J Natl Cancer Inst. 2007;99(4):272-282. doi:10.1093/jnci/djk049PubMedGoogle ScholarCrossref
14.
Powles  TJ, Ashley  S, Tidy  A, Smith  IE, Dowsett  M.  Twenty-year follow-up of the Royal Marsden randomized, double-blinded tamoxifen breast cancer prevention trial.  J Natl Cancer Inst. 2007;99(4):283-290. doi:10.1093/jnci/djk050PubMedGoogle ScholarCrossref
15.
Cuzick  J, Sestak  I, Cawthorn  S,  et al; IBIS-I Investigators.  Tamoxifen for prevention of breast cancer: extended long-term follow-up of the IBIS-I breast cancer prevention trial.  Lancet Oncol. 2015;16(1):67-75. doi:10.1016/S1470-2045(14)71171-4PubMedGoogle ScholarCrossref
16.
Siu  AL; U.S. Preventive Services Task Force.  Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement.  Ann Intern Med. 2016;164(4):279-296. doi:10.7326/M15-2886PubMedGoogle ScholarCrossref
17.
US Preventive Services Task Force (USPSTF). Recommendations for Primary Care Practice. USPSTF website. https://www.uspreventiveservicestaskforce.org/Page/Name/recommendations. 2018. Accessed November 23, 2018.
18.
PDQ® Screening and Prevention Editorial Board, National Cancer Institute (NCI). PDQ Breast Cancer Prevention (PDQ®)—Patient Version. NCI website. https://www.cancer.gov/types/breast/patient/breast-prevention-pdq. Updated June 20, 2019. Accessed August 6, 2019.
19.
Centers for Disease Control and Prevention (CDC). What can I do to reduce my risk of breast cancer? CDC website. https://www.cdc.gov/cancer/breast/basic_info/prevention.htm. September 11, 2018. Accessed August 2, 2019.
20.
Breast Cancer Surveillance Consortium (BCSC). Breast Cancer Surveillance Consortium Risk Calculator. BCSC website. https://tools.bcsc-scc.org/bc5yearrisk/calculator.htm. 2015. Accessed November 23, 2018.
21.
Kaplan  CP, Haas  JS, Pérez-Stable  EJ, Des Jarlais  G, Gregorich  SE.  Factors affecting breast cancer risk reduction practices among California physicians.  Prev Med. 2005;41(1):7-15. doi:10.1016/j.ypmed.2004.09.041PubMedGoogle ScholarCrossref
22.
Corbelli  J, Borrero  S, Bonnema  R,  et al.  Use of the Gail model and breast cancer preventive therapy among three primary care specialties.  J Womens Health (Larchmt). 2014;23(9):746-752. doi:10.1089/jwh.2014.4742PubMedGoogle ScholarCrossref
23.
Armstrong  K, Quistberg  DA, Micco  E, Domchek  S, Guerra  C.  Prescription of tamoxifen for breast cancer prevention by primary care physicians.  Arch Intern Med. 2006;166(20):2260-2265. doi:10.1001/archinte.166.20.2260PubMedGoogle ScholarCrossref
24.
Smith  SG, Sestak  I, Forster  A,  et al.  Factors affecting uptake and adherence to breast cancer chemoprevention: a systematic review and meta-analysis.  Ann Oncol. 2016;27(4):575-590. doi:10.1093/annonc/mdv590PubMedGoogle ScholarCrossref
25.
Fagerlin  A, Zikmund-Fisher  BJ, Nair  V,  et al.  Women’s decisions regarding tamoxifen for breast cancer prevention: responses to a tailored decision aid.  Breast Cancer Res Treat. 2010;119(3):613-620. doi:10.1007/s10549-009-0618-4PubMedGoogle ScholarCrossref
26.
Melnikow  J, Paterniti  D, Azari  R,  et al.  Preferences of Women Evaluating Risks of Tamoxifen (POWER) study of preferences for tamoxifen for breast cancer risk reduction.  Cancer. 2005;103(10):1996-2005. doi:10.1002/cncr.20981PubMedGoogle ScholarCrossref
27.
McKay  A, Martin  W, Latosinsky  S.  How should we inform women at higher risk of breast cancer about tamoxifen? an approach with a decision guide.  Breast Cancer Res Treat. 2005;94(2):153-159. doi:10.1007/s10549-005-6932-6PubMedGoogle ScholarCrossref
28.
Paterniti  DA, Melnikow  J, Nuovo  J,  et al.  “I’m going to die of something anyway”: women’s perceptions of tamoxifen for breast cancer risk reduction.  Ethn Dis. 2005;15(3):365-372.PubMedGoogle Scholar
29.
Fagerlin  A, Dillard  AJ, Smith  DM,  et al.  Women’s interest in taking tamoxifen and raloxifene for breast cancer prevention: response to a tailored decision aid.  Breast Cancer Res Treat. 2011;127(3):681-688. doi:10.1007/s10549-011-1450-1PubMedGoogle ScholarCrossref
30.
Gail  MH, Brinton  LA, Byar  DP,  et al.  Projecting individualized probabilities of developing breast cancer for white females who are being examined annually.  J Natl Cancer Inst. 1989;81(24):1879-1886. doi:10.1093/jnci/81.24.1879PubMedGoogle ScholarCrossref
31.
Adams-Campbell  LL, Makambi  KH, Palmer  JR, Rosenberg  L.  Diagnostic accuracy of the Gail model in the Black Women’s Health Study.  Breast J. 2007;13(4):332-336. doi:10.1111/j.1524-4741.2007.00439.xPubMedGoogle ScholarCrossref
32.
Chen  J, Pee  D, Ayyagari  R,  et al.  Projecting absolute invasive breast cancer risk in white women with a model that includes mammographic density.  J Natl Cancer Inst. 2006;98(17):1215-1226. doi:10.1093/jnci/djj332PubMedGoogle ScholarCrossref
33.
Costantino  JP, Gail  MH, Pee  D,  et al.  Validation studies for models projecting the risk of invasive and total breast cancer incidence.  J Natl Cancer Inst. 1999;91(18):1541-1548. doi:10.1093/jnci/91.18.1541PubMedGoogle ScholarCrossref
34.
Gail  MH, Costantino  JP, Pee  D,  et al.  Projecting individualized absolute invasive breast cancer risk in African American women.  J Natl Cancer Inst. 2007;99(23):1782-1792. doi:10.1093/jnci/djm223PubMedGoogle ScholarCrossref
35.
Matsuno  RK, Costantino  JP, Ziegler  RG,  et al.  Projecting individualized absolute invasive breast cancer risk in Asian and Pacific Islander American women.  J Natl Cancer Inst. 2011;103(12):951-961. doi:10.1093/jnci/djr154PubMedGoogle ScholarCrossref
36.
Rockhill  B, Spiegelman  D, Byrne  C, Hunter  DJ, Colditz  GA.  Validation of the Gail et al. model of breast cancer risk prediction and implications for chemoprevention.  J Natl Cancer Inst. 2001;93(5):358-366. doi:10.1093/jnci/93.5.358PubMedGoogle ScholarCrossref
37.
Tice  JA, Cummings  SR, Smith-Bindman  R, Ichikawa  L, Barlow  WE, Kerlikowske  K.  Using clinical factors and mammographic breast density to estimate breast cancer risk: development and validation of a new predictive model.  Ann Intern Med. 2008;148(5):337-347. doi:10.7326/0003-4819-148-5-200803040-00004PubMedGoogle ScholarCrossref
38.
Barlow  WE, White  E, Ballard-Barbash  R,  et al.  Prospective breast cancer risk prediction model for women undergoing screening mammography.  J Natl Cancer Inst. 2006;98(17):1204-1214. doi:10.1093/jnci/djj331PubMedGoogle ScholarCrossref
39.
Tice  JA, Miglioretti  DL, Li  CS, Vachon  CM, Gard  CC, Kerlikowske  K.  Breast density and benign breast disease: risk assessment to identify women at high risk of breast cancer.  J Clin Oncol. 2015;33(28):3137-3143. doi:10.1200/JCO.2015.60.8869PubMedGoogle ScholarCrossref
40.
Colditz  GA, Rosner  B.  Cumulative risk of breast cancer to age 70 years according to risk factor status: data from the Nurses’ Health Study.  Am J Epidemiol. 2000;152(10):950-964. doi:10.1093/aje/152.10.950PubMedGoogle ScholarCrossref
41.
Rockhill  B, Byrne  C, Rosner  B, Louie  MM, Colditz  G.  Breast cancer risk prediction with a log-incidence model: evaluation of accuracy.  J Clin Epidemiol. 2003;56(9):856-861. doi:10.1016/S0895-4356(03)00124-0PubMedGoogle ScholarCrossref
42.
Tamimi  RM, Rosner  B, Colditz  GA.  Evaluation of a breast cancer risk prediction model expanded to include category of prior benign breast disease lesion.  Cancer. 2010;116(21):4944-4953. doi:10.1002/cncr.25386PubMedGoogle ScholarCrossref
43.
Colditz  GA, Rosner  BA, Chen  WY, Holmes  MD, Hankinson  SE.  Risk factors for breast cancer according to estrogen and progesterone receptor status.  J Natl Cancer Inst. 2004;96(3):218-228. doi:10.1093/jnci/djh025PubMedGoogle ScholarCrossref
44.
Tyrer  J, Duffy  SW, Cuzick  J.  A breast cancer prediction model incorporating familial and personal risk factors.  Stat Med. 2004;23(7):1111-1130. doi:10.1002/sim.1668PubMedGoogle ScholarCrossref
45.
Amir  E, Evans  DG, Shenton  A,  et al.  Evaluation of breast cancer risk assessment packages in the family history evaluation and screening programme.  J Med Genet. 2003;40(11):807-814. doi:10.1136/jmg.40.11.807PubMedGoogle ScholarCrossref
46.
Boughey  JC, Hartmann  LC, Anderson  SS,  et al.  Evaluation of the Tyrer-Cuzick (International Breast Cancer Intervention Study) model for breast cancer risk prediction in women with atypical hyperplasia.  J Clin Oncol. 2010;28(22):3591-3596. doi:10.1200/JCO.2010.28.0784PubMedGoogle ScholarCrossref
47.
Brentnall  AR, Harkness  EF, Astley  SM,  et al.  Mammographic density adds accuracy to both the Tyrer-Cuzick and Gail breast cancer risk models in a prospective UK screening cohort  [published online December 1, 2015].  Breast Cancer Res. 2015;17(1):147. doi:10.1186/s13058-015-0653-5PubMedGoogle ScholarCrossref
48.
Chlebowski  RT, Anderson  GL, Lane  DS,  et al; Women’s Health Initiative Investigators.  Predicting risk of breast cancer in postmenopausal women by hormone receptor status.  J Natl Cancer Inst. 2007;99(22):1695-1705. doi:10.1093/jnci/djm224PubMedGoogle ScholarCrossref
49.
Boyle  P, Mezzetti  M, La Vecchia  C, Franceschi  S, Decarli  A, Robertson  C.  Contribution of three components to individual cancer risk predicting breast cancer risk in Italy.  Eur J Cancer Prev. 2004;13(3):183-191. doi:10.1097/01.cej.0000130014.83901.53PubMedGoogle ScholarCrossref
50.
Decarli  A, Calza  S, Masala  G, Specchia  C, Palli  D, Gail  MH.  Gail model for prediction of absolute risk of invasive breast cancer: independent evaluation in the Florence-European Prospective Investigation Into Cancer and Nutrition cohort.  J Natl Cancer Inst. 2006;98(23):1686-1693. doi:10.1093/jnci/djj463PubMedGoogle ScholarCrossref
51.
Petracci  E, Decarli  A, Schairer  C,  et al.  Risk factor modification and projections of absolute breast cancer risk.  J Natl Cancer Inst. 2011;103(13):1037-1048. doi:10.1093/jnci/djr172PubMedGoogle ScholarCrossref
52.
Cuzick  J, Forbes  J, Edwards  R,  et al; IBIS Investigators.  First results from the International Breast Cancer Intervention Study (IBIS-I): a randomised prevention trial.  Lancet. 2002;360(9336):817-824. doi:10.1016/S0140-6736(02)09962-2PubMedGoogle ScholarCrossref
53.
Fisher  B, Costantino  JP, Wickerham  DL,  et al.  Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study.  J Natl Cancer Inst. 1998;90(18):1371-1388. doi:10.1093/jnci/90.18.1371PubMedGoogle ScholarCrossref
54.
Day  R, Ganz  PA, Costantino  JP.  Tamoxifen and depression: more evidence from the National Surgical Adjuvant Breast and Bowel Project’s Breast Cancer Prevention (P-1) randomized study.  J Natl Cancer Inst. 2001;93(21):1615-1623. doi:10.1093/jnci/93.21.1615PubMedGoogle ScholarCrossref
55.
Powles  T, Eeles  R, Ashley  S,  et al.  Interim analysis of the incidence of breast cancer in the Royal Marsden Hospital tamoxifen randomised chemoprevention trial.  Lancet. 1998;352(9122):98-101. doi:10.1016/S0140-6736(98)85012-5PubMedGoogle ScholarCrossref
56.
Veronesi  U, Maisonneuve  P, Costa  A,  et al; Italian Tamoxifen Prevention Study.  Prevention of breast cancer with tamoxifen: preliminary findings from the Italian randomised trial among hysterectomised women.  Lancet. 1998;352(9122):93-97. doi:10.1016/S0140-6736(98)85011-3PubMedGoogle ScholarCrossref
57.
Veronesi  U, Maisonneuve  P, Rotmensz  N,  et al; Italian Tamoxifen Study Group.  Tamoxifen for the prevention of breast cancer: late results of the Italian Randomized Tamoxifen Prevention Trial among women with hysterectomy.  J Natl Cancer Inst. 2007;99(9):727-737. doi:10.1093/jnci/djk154PubMedGoogle ScholarCrossref
58.
Veronesi  U, Maisonneuve  P, Rotmensz  N,  et al; Italian Tamoxifen Study Group.  Italian randomized trial among women with hysterectomy: tamoxifen and hormone-dependent breast cancer in high-risk women.  J Natl Cancer Inst. 2003;95(2):160-165. doi:10.1093/jnci/95.2.160PubMedGoogle ScholarCrossref
59.
Decensi  A, Maisonneuve  P, Rotmensz  N,  et al; Italian Tamoxifen Study Group.  Effect of tamoxifen on venous thromboembolic events in a breast cancer prevention trial.  Circulation. 2005;111(5):650-656. doi:10.1161/01.CIR.0000154545.84124.ACPubMedGoogle ScholarCrossref
60.
Fisher  B, Costantino  JP, Wickerham  DL,  et al.  Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study.  J Natl Cancer Inst. 2005;97(22):1652-1662. doi:10.1093/jnci/dji372PubMedGoogle ScholarCrossref
61.
DeCensi  A, Bonanni  B, Maisonneuve  P,  et al; Italian HOT Study Group.  A phase-III prevention trial of low-dose tamoxifen in postmenopausal hormone replacement therapy users: the HOT study.  Ann Oncol. 2013;24(11):2753-2760. doi:10.1093/annonc/mdt244PubMedGoogle ScholarCrossref
62.
Ettinger  B, Black  DM, Mitlak  BH,  et al; Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators.  Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial.  JAMA. 1999;282(7):637-645. doi:10.1001/jama.282.7.637PubMedGoogle ScholarCrossref
63.
Cummings  SR, Eckert  S, Krueger  KA,  et al.  The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial.  JAMA. 1999;281(23):2189-2197. doi:10.1001/jama.281.23.2189PubMedGoogle ScholarCrossref
64.
Cauley  JA, Norton  L, Lippman  ME,  et al.  Continued breast cancer risk reduction in postmenopausal women treated with raloxifene: 4-year results from the MORE trial.  Breast Cancer Res Treat. 2001;65(2):125-134. doi:10.1023/A:1006478317173PubMedGoogle ScholarCrossref
65.
Barrett-Connor  E, Grady  D, Sashegyi  A,  et al; MORE Investigators (Multiple Outcomes of Raloxifene Evaluation).  Raloxifene and cardiovascular events in osteoporotic postmenopausal women: four-year results from the MORE (Multiple Outcomes of Raloxifene Evaluation) randomized trial.  JAMA. 2002;287(7):847-857. doi:10.1001/jama.287.7.847PubMedGoogle ScholarCrossref
66.
Delmas  PD, Ensrud  KE, Adachi  JD,  et al; Mulitple Outcomes of Raloxifene Evaluation Investigators.  Efficacy of raloxifene on vertebral fracture risk reduction in postmenopausal women with osteoporosis: four-year results from a randomized clinical trial.  J Clin Endocrinol Metab. 2002;87(8):3609-3617. doi:10.1210/jcem.87.8.8750PubMedGoogle ScholarCrossref
67.
Delmas  PD, Genant  HK, Crans  GG,  et al.  Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial.  Bone. 2003;33(4):522-532. doi:10.1016/S8756-3282(03)00241-2PubMedGoogle ScholarCrossref
68.
Grady  D, Ettinger  B, Moscarelli  E,  et al; Multiple Outcomes of Raloxifene Evaluation Investigators.  Safety and adverse effects associated with raloxifene: multiple outcomes of raloxifene evaluation.  Obstet Gynecol. 2004;104(4):837-844. doi:10.1097/01.AOG.0000137349.79204.b8PubMedGoogle ScholarCrossref
69.
Barrett-Connor  E, Cauley  JA, Kulkarni  PM, Sashegyi  A, Cox  DA, Geiger  MJ.  Risk-benefit profile for raloxifene: 4-year data from the Multiple Outcomes of Raloxifene Evaluation (MORE) randomized trial.  J Bone Miner Res. 2004;19(8):1270-1275. doi:10.1359/JBMR.040406PubMedGoogle ScholarCrossref
70.
Silverman  SL, Delmas  PD, Kulkarni  PM, Stock  JL, Wong  M, Plouffe  L  Jr.  Comparison of fracture, cardiovascular event, and breast cancer rates at 3 years in postmenopausal women with osteoporosis.  J Am Geriatr Soc. 2004;52(9):1543-1548. doi:10.1111/j.1532-5415.2004.52420.xPubMedGoogle ScholarCrossref
71.
Martino  S, Disch  D, Dowsett  SA, Keech  CA, Mershon  JL.  Safety assessment of raloxifene over eight years in a clinical trial setting.  Curr Med Res Opin. 2005;21(9):1441-1452. doi:10.1185/030079905X61839PubMedGoogle ScholarCrossref
72.
Duvernoy  CS, Kulkarni  PM, Dowsett  SA, Keech  CA.  Vascular events in the Multiple Outcomes of Raloxifene Evaluation (MORE) trial: incidence, patient characteristics, and effect of raloxifene.  Menopause. 2005;12(4):444-452. doi:10.1097/01.GME.0000151653.02620.89PubMedGoogle ScholarCrossref
73.
Keech  CA, Sashegyi  A, Barrett-Connor  E.  Year-by-year analysis of cardiovascular events in the Multiple Outcomes of Raloxifene Evaluation (MORE) trial.  Curr Med Res Opin. 2005;21(1):135-140. doi:10.1185/030079904X18045PubMedGoogle ScholarCrossref
74.
Siris  ES, Harris  ST, Eastell  R,  et al; Continuing Outcomes Relevant to Evista (CORE) Investigators.  Skeletal effects of raloxifene after 8 years: results from the continuing outcomes relevant to Evista (CORE) study.  J Bone Miner Res. 2005;20(9):1514-1524. doi:10.1359/JBMR.050509PubMedGoogle ScholarCrossref
75.
Lippman  ME, Cummings  SR, Disch  DP,  et al.  Effect of raloxifene on the incidence of invasive breast cancer in postmenopausal women with osteoporosis categorized by breast cancer risk.  Clin Cancer Res. 2006;12(17):5242-5247. doi:10.1158/1078-0432.CCR-06-0688PubMedGoogle ScholarCrossref
76.
Barrett-Connor  E, Mosca  L, Collins  P,  et al; Raloxifene Use for The Heart (RUTH) Trial Investigators.  Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women.  N Engl J Med. 2006;355(2):125-137. doi:10.1056/NEJMoa062462PubMedGoogle ScholarCrossref
77.
Ensrud  KE, Stock  JL, Barrett-Connor  E,  et al.  Effects of raloxifene on fracture risk in postmenopausal women: the Raloxifene Use for the Heart trial.  J Bone Miner Res. 2008;23(1):112-120. doi:10.1359/jbmr.070904PubMedGoogle ScholarCrossref
78.
Grady  D, Cauley  JA, Geiger  MJ,  et al; Raloxifene Use for The Heart Trial Investigators.  Reduced incidence of invasive breast cancer with raloxifene among women at increased coronary risk.  J Natl Cancer Inst. 2008;100(12):854-861. doi:10.1093/jnci/djn153PubMedGoogle ScholarCrossref
79.
Land  SR, Wickerham  DL, Costantino  JP,  et al.  Patient-reported symptoms and quality of life during treatment with tamoxifen or raloxifene for breast cancer prevention: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial.  JAMA. 2006;295(23):2742-2751. doi:10.1001/jama.295.23.joc60075PubMedGoogle ScholarCrossref
80.
Vogel  VG, Costantino  JP, Wickerham  DL,  et al; National Surgical Adjuvant Breast and Bowel Project (NSABP).  Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial.  JAMA. 2006;295(23):2727-2741. doi:10.1001/jama.295.23.joc60074PubMedGoogle ScholarCrossref
81.
Vogel  VG, Costantino  JP, Wickerham  DL,  et al; National Surgical Adjuvant Breast and Bowel Project.  Update of the National Surgical Adjuvant Breast and Bowel Project Study of Tamoxifen and Raloxifene (STAR) P-2 Trial: preventing breast cancer.  Cancer Prev Res (Phila). 2010;3(6):696-706. doi:10.1158/1940-6207.CAPR-10-0076PubMedGoogle ScholarCrossref
82.
Maunsell  E, Goss  PE, Chlebowski  RT,  et al.  Quality of life in MAP.3 (Mammary Prevention 3): a randomized, placebo-controlled trial evaluating exemestane for prevention of breast cancer.  J Clin Oncol. 2014;32(14):1427-1436. doi:10.1200/JCO.2013.51.2483PubMedGoogle ScholarCrossref
83.
Goss  PE, Ingle  JN, Alés-Martínez  JE,  et al; NCIC CTG MAP.3 Study Investigators.  Exemestane for breast-cancer prevention in postmenopausal women  [published correction appears in N Engl J Med. 2011;365(14):1361].  N Engl J Med. 2011;364(25):2381-2391. doi:10.1056/NEJMoa1103507PubMedGoogle ScholarCrossref
84.
Cuzick  J, Sestak  I, Forbes  JF,  et al; IBIS-II Investigators.  Anastrozole for prevention of breast cancer in high-risk postmenopausal women (IBIS-II): an international, double-blind, randomised placebo-controlled trial  [published correction appears in Lancet. 2014;383(9922):1040].  Lancet. 2014;383(9922):1041-1048. doi:10.1016/S0140-6736(13)62292-8PubMedGoogle ScholarCrossref
85.
Sestak  I, Singh  S, Cuzick  J,  et al.  Changes in bone mineral density at 3 years in postmenopausal women receiving anastrozole and risedronate in the IBIS-II bone substudy: an international, double-blind, randomised, placebo-controlled trial  [published correction appears in Lancet Oncol. 2014;15(13):e587].  Lancet Oncol. 2014;15(13):1460-1468. doi:10.1016/S1470-2045(14)71035-6PubMedGoogle ScholarCrossref
86.
Spagnolo  F, Sestak  I, Howell  A, Forbes  JF, Cuzick  J.  Anastrozole-induced carpal tunnel syndrome: results from the International Breast Cancer Intervention Study II prevention trial.  J Clin Oncol. 2016;34(2):139-143. doi:10.1200/JCO.2015.63.4972PubMedGoogle ScholarCrossref
87.
Early Breast Cancer Trialists’ Collaborative Group (EBCTCG).  Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials.  Lancet. 2015;386(10001):1341-1352. doi:10.1016/S0140-6736(15)61074-1PubMedGoogle ScholarCrossref
88.
Moyer  VA; U.S. Preventive Services Task Force.  Medications to decrease the risk for breast cancer in women: recommendations from the U.S. Preventive Services Task Force recommendation statement.  Ann Intern Med. 2013;159(10):698-708.PubMedGoogle Scholar
89.
Visvanathan  K, Hurley  P, Bantug  E,  et al.  Use of pharmacologic interventions for breast cancer risk reduction: American Society of Clinical Oncology clinical practice guideline.  J Clin Oncol. 2013;31(23):2942-2962. doi:10.1200/JCO.2013.49.3122PubMedGoogle ScholarCrossref
90.
National Comprehensive Cancer Network (NCCN). NCCN Clinical Practice Guidelines in Oncology: Breast Cancer Risk Reduction, Version 2. NCCN website. https://www.nccn.org/professionals/physician_gls/default.aspx. 2018. Accessed August 1, 2019.
91.
Committee on Practice Bulletins–Gynecology, Committee on Genetics, Society of Gynecologic Oncology.  Practice Bulletin No. 182: hereditary breast and ovarian cancer syndrome.  Obstet Gynecol. 2017;130(3):e110-e126. doi:10.1097/AOG.0000000000002296PubMedGoogle ScholarCrossref
92.
 Committee Opinion No. 601: tamoxifen and uterine cancer.  Obstet Gynecol. 2014;123(6):1394-1397. doi:10.1097/01.AOG.0000450757.18294.cfPubMedGoogle ScholarCrossref
93.
American Academy of Family Physicians (AAFP). Clinical preventive service recommendation: medications to reduce breast cancer risk. AAFP website. https://www.aafp.org/patient-care/clinical-recommendations/all/breast-cancer-medication.html. Accessed August 2, 2019.
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