Doc, Should I Take This Pill or Not?

Lidia Schapira, MD; Paul E. Goss, MD, PhD, FRCP(UK)


February 20, 2014

In This Article

Chemoprevention "Enormously Underutilized"

Editor's note: Growing evidence indicates that chemoprevention with aromatase inhibitors[1,2,3] and selective estrogen receptor modulators (SERMS)[4,5,6] can significantly reduce the risk for breast cancer for certain women, yet women in the United States have not embraced this prevention strategy. Paul E. Goss, MD, PhD, Professor of Medicine, Harvard Medical School, and Co-Director, Breast Cancer Disease Program, Dana-Farber/Harvard Cancer Center, Boston, Massachusetts, is a leader in the research on aromatase inhibitors and their role in breast cancer prevention and treatment. In an interview for Medscape, Lidia Schapira, MD, Assistant Professor at Harvard Medical School, spoke to Dr. Goss, who identified key points to help doctors discuss with patients whether they should consider breast cancer prophylaxis.

Dr. Schapira: Women are already afraid of getting breast cancer. How should a primary care doctor or gynecologist approach the idea of screening women for breast cancer risk during their annual checkup?

Dr. Goss: Breast cancer is a public health problem of considerable extent, and despite having very effective agents, breast cancer chemoprevention has not gained traction among the public despite all the publication and press that it has received. Chemoprevention of breast cancer remains an enormously underutilized tool. Compared with statins or antihypertensive agents, the use of breast cancer chemopreventive drugs is very low, and yet the safety is as good if not better.

Having a frank and open discussion, without inducing fear, about a woman's risk for breast cancer and the potential benefits of chemoprevention is the best way forward.

Dr. Schapira: Should her doctors talk to her about taking medications to reduce her risk?

Dr. Goss: Women should see their breast health the same way they see their bone health, their cardiovascular health, and their overall health, particularly as they age, because breast cancer is predominantly a disease of aging women. The National Cancer Institute introduced an ABC (agent, biomarker, cohort) approach to the prevention of breast cancer, and doctors can have that conversation with women along these lines.

A is for agent. Do we have effective agents that can prevent the risk of getting breast cancer? The answer is yes, in both pre- and postmenopausal women.

B -- Do we have a biomarker? Is there something such as lowering your cholesterol or your blood pressure that a patient can be shown as a measure of efficacy if you give such a treatment? For breast cancer prevention there is not as yet a biomarker, and therein lies one of the problems with acceptance of preventative therapy for breast cancer.

C is for cohort. These are the women who most likely need to have this conversation and to come to a decision about breast cancer prevention.


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