Each year, about 215,000 women in the United States are diagnosed with breast cancer. And each year, approximately 40,000 women die from this disease. Although annual mammograms and monthly self-breast exams are a woman’s best defense for early detection, there may be other alternatives for prevention.

“Women who are at high risk for developing breast cancer should talk to their physician about chemoprevention,” says Raymond J. Vivacqua, M.D. chief of the Division of Hematology/Oncology at Crozer-Chester Medical Center and medical director of the Crozer Regional Cancer Center. “Drugs like tamoxifen and raloxifene have shown success in helping protect some high-risk women from getting breast cancer. However, before taking one of these drugs, it’s important that they understand the benefits and the risks associated with them.”

Women are considered to be at a high risk of getting breast cancer if they have: 

• A personal history of breast cancer
• A strong family history of breast cancer
• A mutation in one of the breast cancer genes
• A breast biopsy revealing abnormal cells in a duct or lobule of the breast.

“To assess a woman’s risk for breast cancer, a physician would calculate her Gail model score,” says Lee Bogart, M.D., chief of the Section Hematology/Oncology at Taylor Hospital. “This model reviews certain risk factors and gives a score based on a woman’s five-year risk and her lifetime risk of developing breast cancer. A five-year risk estimate of 1.66 percent or greater indicates an increased risk of breast cancer. This score means her chances are 16 to 17 in 1,000 of developing breast cancer over the next five years.”

Over the past years, tamoxifen has been the drug of choice in breast cancer prevention. Originally used to treat advanced cancer, and for a woman whose cancer is early-stage estrogen receptor positive, its purpose was to prevent the cancer from coming back after treatment. However, studies from several clinical trials found that tamoxifen use resulted in a reduction in risks of both invasive and noninvasive breast cancer.

Although tamoxifen has been clinically proven to reduce the risk of breast cancer, it does come with the risk of side effects. Possible side effects include hot flashes, vaginal discharge or dryness, menstrual irregularities, headaches and nausea. Although uncommon, it can also cause potentially life-threatening blood clots, endometrial cancer or uterine tumors.

Until recently, tamoxifen had been the only chemoprevention therapy option for women. However, the release of the initial results of the Study of Tamoxifen and Raloxifene (STAR) earlier this year show that the drug raloxifene, currently used to prevent and treat osteoporosis in postmenopausal women, works as well as tamoxifen in reducing breast cancer risk for postmenopausal women at increased risk of the disease.

“In STAR, both drugs reduced the risk of developing invasive breast cancer by about 50 percent,” says John Sprandio, M.D., chief of the Section of Hematology/Oncology for Delaware County Memorial Hospital, medical director of the Delaware County Regional Cancer Center and principal investigator for the STAR trial at DCMH. “The study also showed that like tamoxifen, raloxifene had similar side effects, however it had 36 percent fewer uterine cancers and 29 percent fewer blood clots than the women who were assigned to take tamoxifen.”

Women taking either drug had equivalent numbers of strokes, heart attacks, and bone fractures. Additionally, the initial results from STAR suggest that raloxifene does not increase the risk of developing a cataract, as tamoxifen does. Crozer-Chester Medical Center patients also participated in the STAR trial under the direction of principal investigator Michael Soojian, M.D.

When deciding whether or not a woman should take this proactive approach to prevent breast cancer, physicians will consider the individual’s age, risk status, family history, medical history, lifestyle and personal preference. Individually, these many factors highlight the necessity of a customized approach to the treatment of each patient, but together, the criteria will help the physician and patient determine which chemoprevention drug is best for her.

All Crozer-Keystone physicians agree that chemoprevention is not for everyone. Patients should understand the benefits, risks and side effects associated with both drugs and carefully weigh the pros and cons before beginning drug therapy.

To find a Crozer-Keystone physician who’s right for you and to schedule an appointment, call 1-800-CK-HEALTH (1-800-254-3258).

To schedule a mammogram, contact the Crozer-Keystone Health System medical imaging appointment line at 1-866-5-CK-XRAY (1-866-525-9729) or visit http://ckimaging.crozer.org.