U.S. Preventive Services Task Force

Chemoprevention for Breast Cancer

Release Date: July 2002

Summary of Recommendations / Supporting Documents

Summary of Recommendations

• The U.S. Preventive Services Task Force (USPSTF) recommends against routine use of tamoxifen or raloxifene for the primary prevention of breast cancer in women at low or average risk for breast cancer. (Select Clinical Considerations for a discussion of risk.)

  Rating: D recommendation.

  Rationale: The USPSTF found fair evidence that tamoxifen and raloxifene may prevent some breast cancers in women at low or average risk for breast cancer, based on extrapolation from studies of women at higher risk. The USPSTF concluded, however, that the potential harms of chemoprevention may outweigh the potential benefits in women who are not at high risk for breast cancer.

• The USPSTF recommends that clinicians discuss chemoprevention with women at high risk for breast cancer and at low risk for adverse effects of chemoprevention. (Select Clinical Considerations for a discussion of risk.) Clinicians should inform patients of the potential benefits and harms of chemoprevention.

  Rating: B recommendation.

  Rationale: The USPSTF found fair evidence that treatment with tamoxifen can significantly reduce the risk for invasive estrogen-receptor-positive breast cancer in women at high risk for breast cancer and that the likelihood of benefit increases as the risk for breast cancer increases. The USPSTF found consistent but less abundant evidence for the benefit of raloxifene. The USPSTF found good evidence that tamoxifen and raloxifene increase the risk for thromboembolic events (for example, stroke, pulmonary embolism, and deep venous thrombosis) and symptomatic side effects (for example, hot flashes) and that tamoxifen, but not raloxifene, increases the risk for endometrial cancer. The USPSTF concluded that the balance of benefits and harms may be favorable for some high-risk women but will depend on breast cancer risk, risk for potential harms, and individual patient preferences.

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Supporting Documents

Chemoprevention for Breast Cancer, July 2002
Recommendations and Rationale (PDF file, 89 KB)
Summary of the Evidence (PDF File, 224 KB)
Systematic Evidence Review (File Download, 183 KB)
What's New (PDF File, 75 KB)

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