Women at risk of breast cancer should be offered tamoxifen
Women in England and Wales with a family history of breast cancer can now be offered chemopreventive drugs tamoxifen and raloxifene to prevent the disease, new clinical guidelines from the National Institute for Health and Care Excellence say. Scotland has announced a similar move.
About 3 per cent of women in England and Wales aged 35 years or older could be eligible to receive the drugs to prevent breast cancer, equating to just under 490,000 women.
NICE says tamoxifen or raloxifene taken daily for five years can cut breast cancer risk by 30 to 40 per cent. Women with a "moderate" or "high" risk of developing breast cancer because of their family history but who have not had the disease themselves can now be offered tamoxifen or raloxifene for five years to prevent it.
However, Baroness Delyth Morgan, the chief executive of the Breast Cancer Campaign, said the drugs have side effects and will not have the same risk-reducing impact for these women as preventive surgery.
The products are unlicensed as preventive treatments so doctors wanting to prescribe them in this way should follow relevant professional guidance, taking full responsibility for the decision. Informed consent should also be obtained from the woman and documented, adds NICE. The guideline largely follows NICE’s draft recommendations that were published earlier this year.
The guidelines also say that the NHS should offer testing to otherwise healthy people if it is likely that they have a genetic mutation and have no living relative with cancer who could be tested instead.
Doctors should calculate a person’s risk of getting breast cancer by assessing their family history and calculate the possibility of that person carrying a genetic fault such as a BRCA1 or BRCA2 mutation, according to the guidelines.
MRI screening should be offered every year to all women aged 30–49 years who have, or have had, breast cancer and who remain at high risk of the disease. This includes those with a BRCA1 or BRCA2 mutation.
Separately, Scotland’s health secretary Alex Neil announced that women who have two or more family members with breast cancer will be offered tamoxifen for five years, where clinically appropriate. Genetic testing is also to be offered to women in Scotland who have a 10 per cent chance of having a faulty gene.
Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2013.11122766
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