Regarding breast cancer risk, when should clinicians offer risk-reducing medications like tamoxifen or raloxifene?

• A. To women at increased risk for breast cancer who are at low risk for adverse effects
• B. Only to women with confirmed BRCA mutations
• C. To all women regardless of risk
• D. Never offer risk-reducing medications

Answer: (A)

The idea behind risk-reducing medications is that they should be offered to women who have a higher-than-average risk of developing breast cancer and who are not likely to suffer significant harms from the medication. Tamoxifen and raloxifene can lower the chance of developing breast cancer, especially ER-positive disease, but they also carry potential harms such as venous thromboembolism, stroke, and, for tamoxifen, endometrial cancer risk. Because of these trade-offs, the recommendation targets women with increased baseline risk who are at low risk for adverse effects, so the benefits outweigh the harms for that group. It isn’t limited only to BRCA mutation carriers, nor is it appropriate to offer these meds to all women regardless of risk, and they aren’t never to be offered.