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    Tamoxifen Not Being Offered to All Those at High Risk for Breast Cancer


    When breast cancer prevention is discussed, women should also be told about other factors that may help cut their risk, such as quitting smoking, exercising, and eating a healthy diet. If women do decide to take tamoxifen, they should also be aware that for women over 50, there is an increased risk of endometrial or uterine cancer, or polyps. Because of this, women on tamoxifen should receive at least a pelvic exam and a Pap smear annually, Goldstein says

    Tamoxifen and another drug, raloxifene, belong to a class of agents known as selective estrogen receptor modulators (SERMs). Raloxifene, a drug commonly used to prevent osteoporosis, is currently being studied in a head-to-head trial with tamoxifen to see if it is as effective and possibly safer than tamoxifen in reducing breast cancer risk in otherwise healthy women who have a high risk of the disease. Both drugs work by binding to estrogen receptors on breast cells and blocking the signals that trigger cells to divide out of control.

    But Goldstein says women shouldn't have to wait for the results of the trial for their doctors to offer tamoxifen to them. "I just want gynecologists to be more aware of the myths and realities of tamoxifen -- what it does and doesn't do," he tells WebMD. "And the myths and realities of [raloxifene] and what it does and doesn't do."

    A gynecologist who spoke to WebMD about the issue agrees that gynecologists need more education if they are going to be able to offer preventive tamoxifen to women at increased risk for breast cancer. But Shashi Lele, MD, says it is unlikely that many gynecologists will prescribe the drug unless patients ask about it. Even then, many gynecologists will refer women to medical oncologists who are more versed in the issue.

    "They are not going to prescribe tamoxifen like they prescribe birth control pills," says Lele, who is chairman of gyn-oncology at the Roswell Park Cancer Institute in Buffalo, N.Y. "I don't know how many gynecologists in routine practice [are familiar enough] with the literature that they can keep themselves attuned to this problem."

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