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    Breast Cancer Prevention Drug Underused

    Women With Abnormal Biopsies Most Likely to Take Tamoxifen

    Millions of Women Could Benefit continued...

    Women who had had a breast biopsy showing abnormal breast cells -- either precancerous cells called atypical hyperplasia or very early breast cancer known as lobular carcinoma in situ -- were far more likely to be offered tamoxifen. In addition, these women were far more likely to take tamoxifen -- 70% agreed to take the drug. The findings are published in the latest online edition of the journal Cancer.

    "It is not surprising that women who had biopsies indicating that something might be wrong would be the ones who were most willing to take tamoxifen," American Cancer Society deputy chief medical officer Len Lichtenfeld, MD, tells WebMD. "Other risk factors like starting your period early or having children late, or even having a family history of breast cancer, may not seem as real." HRT Experience

    Lichtenfeld says the experience with hormone replacement therapy may explain why many doctors are still reluctant to prescribe tamoxifen for breast cancer prevention. Millions of women were told by their doctors that taking menopausal hormone therapy would lower their risk of heart disease until studies showed that the opposite may be true.

    "Preventive therapies have taken a big black eye, and I think a lot of doctors out there may not be convinced that the benefits of tamoxifen outweigh the risks," he says.

    Tamoxifen use has been linked to a small increase in risk for uterine cancers and cataracts and a higher risk of blood clots.

    National Cancer Institute researcher D.L. Wickerham, MD, says it will take time for doctors to accept tamoxifen treatment for breast cancer prevention, just as it took them time to accept tamoxifen as an addition to cancer chemotherapy. Wickerham is a principal researcher for a 19,000-woman breast cancer prevention trial -- called the STAR trial -- comparing tamoxifen with the osteoporosis drug Evista. This study's findings are expected in a little more than two years.

    "Preventive therapy for breast cancer will evolve, physicians will become more comfortable with it, and as a consequence more women will receive these treatments," he says. "We hope that the results from the STAR trial will help take preventive therapy to the next step."

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