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Weighing the Risks and Benefits of Tamoxifen
in Preventing Breast Cancer: variations in age and race
In a recent article in the Journal of the National Cancer Institute, the risks and benefits of tamoxifen in healthy, "at-risk" women were
examined. From the Breast Cancer Prevention Trial, tamoxifen produced a 49% reduction in the risk of an invasive breast cancer. Tamoxifen also was shown to reduce the risk of hip and spine fractures and certain hand
fractures. Adverse effects included an increase in the incidence of endometrial (uterine) cancers, stroke, blood clots (and pulmonary embolus) and cataracts. The net benefit/risk ratio differs according to a woman's age
and race and risk for an invasive breast cancer (including age at menarche, age at first live birth, number of first degree relatives with breast cancer and previous biopsies and whether they showed pre-cancerous
findings). You can calculate this risk by linking to http://cancerTrials.nci.nih.gov
The population that was studied however was comprised of less than 5 % of minorities, including 1.7 % whom were Afro-American. Tamoxifen benefits younger women who are not at as high a risk of developing diseases of aging such as uterine cancer. Tamoxifen does not produce as much of a benefit in older black women (> age 50) where the risk of stroke, blood clots and pulmonary embolus is about 2 to 3 times higher than in white women. Tamoxifen benefits those women where the uterus has been surgically removed (hysterectomy). This article introduces methods in the form of tables which, depending on your age, race and risk will assist you and your physician in making an informed decision to take tamoxifen.
(please note: By using the risk assessment tool, you can also determine your eligibility for the STAR trial)
(Gail MH, et. al. Adapted from J Natl Cancer Inst 1999;91:1829-46)
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