New recommendations from the National Institute for Health and Care Excellence (NICE) in the UK suggest that women preemptively take breast cancer drugs to prevent breast cancer. But is it wise (or even safe) for otherwise healthy women?
"Our draft guideline update recommends the use of anastrozole as a first-line treatment for post-menopausal women at high or medium risk of breast cancer who don't have osteoporosis,” said Mark Baker from NICE.
"The evidence examined by the committee suggests anastrozole will not only reduce the number of breast cancer cases in these women compared to tamoxifen, but it is also a more cost-effective option."
Anastrozole is a medication that lowers estrogen hormone levels in women, and thereby helps to shrink tumors. Similarly, tamoxifen blocks estrogen from attaching to cancer cells, thereby also reducing tumor growth. Both drugs are commonly prescribed to fight breast tumors.
Of note, tamoxifen is approved by the FDA for the prevention of invasive breast cancer in high-risk women. These include women who have a family history of the disease, or who themselves have high-risk mutations in the BRCA 1 and/or BRCA 2 genes.
The new guidelines aim to extend preventative measures with the use of anastrozole. However, since this drug is not yet approved solely for prevention of breast cancer, doctors would have to prescribe this drug off-label.
"This updated guideline is a great first step but we now need to ensure that these risk-reducing options actually make their way to patients that could benefit. Ultimately, if the full potential of anastrozole is to be realized for post-menopausal women, there needs to be far greater awareness and support for [doctors] in prescribing off-label treatments,” said Baroness Morgan, Chief Executive of the charity Breast Cancer Now in the UK.
However, patients and physicians must also weigh the risks of side effects with the preventative medicines. Being chemotherapy drugs, both anastrozole and tamoxifen are associated with severe side effects, such as nausea, vomiting, pain and weakness. In addition, because the drugs affect the estrogen, women may experience hormonal changes, such as hot flashes, weight change, and hair loss.
Additional sources: BBC News