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J Clin Oncol. 2019 Nov 20;37(33):3152-3165. doi: 10.1200/JCO.19.01472. Epub 2019 Sep 3.

Use of Endocrine Therapy for Breast Cancer Risk Reduction: ASCO Clinical Practice Guideline Update.

Author information

1
Johns Hopkins School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
2
University of Kansas Medical Center, Kansas City, KS.
3
Johns Hopkins School of Medicine, Baltimore, MD.
4
University of Texas MD Anderson Cancer Center, Houston, TX.
5
University of Washington, Seattle, WA.
6
National Hospital E.O. Ospedali Galliera S.C. Oncologia Medica, Genoa, Italy; and Queen Mary University of London, United Kingdom.
7
Cancer Care Specialists of Illinois, Swansea, IL.
8
Dana-Farber Cancer Institute, Boston, MA.
9
Yale Cancer Center, New Haven, CT.
10
Northwestern University Feinberg School of Medicine, Chicago, IL.
11
University of Basel Nursing Science, Basel, Switzerland.
12
Mayo Clinic Cancer Center, Rochester, MN.
13
Cancer Care of Western North Carolina, Asheville, NC.
14
Florida International University, Miami, FL.
15
American Society of Clinical Oncology, Alexandria, VA.

Abstract

PURPOSE:

To update the ASCO guideline on pharmacologic interventions for breast cancer risk reduction and provide guidance on clinical issues that arise when deciding to use endocrine therapy for breast cancer risk reduction.

METHODS:

An Expert Panel conducted targeted systematic literature reviews to identify new studies.

RESULTS:

A randomized clinical trial that evaluated the use of anastrozole for reduction of estrogen receptor-positive breast cancers in postmenopausal women at increased risk of developing breast cancer provided the predominant basis for the update.

UPDATED RECOMMENDATIONS:

In postmenopausal women at increased risk, the choice of endocrine therapy now includes anastrozole (1 mg/day) in addition to exemestane (25 mg/day), raloxifene (60 mg/day), or tamoxifen (20 mg/day). The decision regarding choice of endocrine therapy should take into consideration age, baseline comorbidities, and adverse effect profiles. Clinicians should not prescribe anastrozole, exemestane, or raloxifene for breast cancer risk reduction to premenopausal women. Tamoxifen 20 mg/day for 5 years is still considered standard of care for risk reduction in premenopausal women who are at least 35 years old and have completed childbearing. Data on low-dose tamoxifen as an alternative to the standard dose for both pre- and postmenopausal women with intraepithelial neoplasia are discussed in the Clinical Considerations section of this article. Additional information is available at www.asco.org/breast-cancer-guidelines.

PMID:
31479306
DOI:
10.1200/JCO.19.01472

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