In this clip, Dr. David A. Margileth discusses how tamoxifen can be used for prevention in some people, but not others.
One of the questions that we are faced with especially in families that have a history of breast cancer is the question would taking tamoxifen the anti estrogen pill for five years be beneficial this is actually a rather complex question that depends on many factors my sense of a drug for prevention is that it should be incredibly easy should be very non-toxic
Shouldn’t interfere with your life shouldn’t make you worry about long-term toxicity and be cheap tamoxifen for prevention fits some of those but unfortunately not all there are several major studies that have been done over the past 10 or 15 years in trying to answer the question how important or how beneficial is tamoxifen in preventing breast cancer the p1 trial
Which is a large trial done in this country had the best data and in fact showed that the relative risk of recurrence in patients that took five years of tamoxifen was about 50% while that sounds very good that’s the relative risk of recurrence not the absolute risk of recurrence the absolute numbers per hundred people are dependent on that patients risk of breast
Cancer in the first place the other issue that always comes up especially with tamoxifen in the prevention setting is the toxicity of tamoxifen while one can argue that the toxicity of tamoxifen in patients who were treating with established breast cancer is reasonable one worries more when you’re using it in the preventive setting in women obviously that don’t
Have a history of breast cancer those two toxicities are cancers of the uterus and deep vein thrombosis possible pulmonary embolus both of those toxicities are increased with age and while quite rare can occasionally be life-threatening the ideal person to treat with tamoxifen would be a higher risk person such that such that the potential benefit is better that
Ideal person would be a young person with a strong family history of breast cancer who doesn’t have a uterus unfortunately that’s not the most common situation the toxicity as one gets older with an intact uterus pretty soon the toxicity may equal or exceed the benefit the other issue is that there are a number of short term side effects of tamoxifen such as hot
Flashes night sweats vaginal dryness sexual dysfunction that really are more than one should put up with for a drug for prevention when i have a situation like this the patient and i evaluate the numerical potential benefit the potential risks and make a decision at that point whether to do it or not however i think most importantly if we decide to try five years
Of tamoxifen for prevention i will have the patients start on the tamoxifen and then see them a couple months later to see how they’re doing with it if they’re having much trouble at all night sweats hot flashes sex problems it’s just not worth it on the other hand if they come in and say it doesn’t bother them at all then for many situations one is reasonable to
Accrue that benefit with potentially minimal risk it’s often a difficult discussion there are now tables looking at various age groups risk patterns intact uterus or not that actually will give a much better numerical answer to the question as to whether the benefits outweigh the risks and those should probably be looked at in some i i think that while there’s a
Lot of enthusiasm for tamoxifen prevention on a practical sense the majority of patients who head down that road probably in fact do not finish five years of tamoxifen and for many of those patients the benefit risk ratio is not high enough to warrant giving the tamoxifen in the first place hi i’m dr. jay harness and i want to share with you important information
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Transcribed from video
Tamoxifen Indications For Breast Cancer Prevention By Breast Cancer Answers®
