title: Use of pharmacologic interventions for breast cancer risk reduction: American Society of Clinical Oncology clinical practice guideline.
abstract: OBJECTIVE
  To update the 2009 American Society of Clinical Oncology guideline on pharmacologic interventions for breast cancer (BC) risk reduction.
  
  
  METHODS
  A systematic review of randomized controlled trials and meta-analyses published from June 2007 through June 2012 was completed using MEDLINE and Cochrane Collaboration Library. Primary outcome of interest was BC incidence (invasive and noninvasive). Secondary outcomes included BC mortality, adverse events, and net health benefits. Guideline recommendations were revised based on an Update Committee's review of the literature.
  
  
  RESULTS
  Nineteen articles met the selection criteria. Six chemoprevention agents were identified: tamoxifen, raloxifene, arzoxifene, lasofoxifene, exemestane, and anastrozole.
  
  
  CONCLUSIONS
  In women at increased risk of BC age ≥ 35 years, tamoxifen (20 mg per day for 5 years) should be discussed as an option to reduce the risk of estrogen receptor (ER) -positive BC. In postmenopausal women, raloxifene (60 mg per day for 5 years) and exemestane (25 mg per day for 5 years) should also be discussed as options for BC risk reduction. Those at increased BC risk are defined as individuals with a 5-year projected absolute risk of BC ≥ 1.66% (based on the National Cancer Institute BC Risk Assessment Tool or an equivalent measure) or women diagnosed with lobular carcinoma in situ. Use of other selective ER modulators or other aromatase inhibitors to lower BC risk is not recommended outside of a clinical trial. Health care providers are encouraged to discuss the option of chemoprevention among women at increased BC risk. The discussion should include the specific risks and benefits associated with each chemopreventive agent.
authors.affiliation: John Hopkins Medical Institution, Baltimore, MD, USA.
authors.forename: Kala
authors.initials: K
authors.lastname: Visvanathan
authors.forename: Patricia
authors.initials: P
authors.lastname: Hurley
authors.forename: Elissa
authors.initials: E
authors.lastname: Bantug
authors.forename: Powel
authors.initials: P
authors.lastname: Brown
authors.forename: Nananda F
authors.initials: NF
authors.lastname: Col
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Davidson
authors.forename: Andrea
authors.initials: A
authors.lastname: Decensi
authors.forename: Carol
authors.initials: C
authors.lastname: Fabian
authors.forename: Leslie
authors.initials: L
authors.lastname: Ford
authors.forename: Judy
authors.initials: J
authors.lastname: Garber
authors.forename: Maria
authors.initials: M
authors.lastname: Katapodi
authors.forename: Barnett
authors.initials: B
authors.lastname: Kramer
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
authors.forename: Barbara
authors.initials: B
authors.lastname: Parker
authors.forename: Carolyn
authors.initials: C
authors.lastname: Runowicz
authors.forename: Victor G
authors.initials: VG
authors.lastname: Vogel
authors.forename: James L
authors.initials: JL
authors.lastname: Wade
authors.forename: Scott M
authors.initials: SM
authors.lastname: Lippman
mesh_terms: D000328:Adult; D016588:Anticarcinogenic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015201:Meta-Analysis as Topic; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D040242:Risk Reduction Behavior; D013629:Tamoxifen / Q000627:therapeutic use*
chemical_list: D016588:Anticarcinogenic Agents; D013629:Tamoxifen