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Breast Cancer Genetics: The Role of Your Family Physician Part 2

Posted May 20 2013 5:00am
So now that the furor over Angelina Jolie's disclosure has died down, I thought I'd take a closer look at the US Preventive Services Task Force evidence review published last month in Annals of Internal Medicine in which they concluded that selective estrogen receptor modulators can reduce the risk of breast cancer.  However, if you'll recall that there's no such thing as a free lunch, then it shouldn't come as a surprise that use of tamoxifen was associated w/greater risk of thromboembolism & endometrial cancer than raloxifene, albeit tamoxifen reduced breast cancer risk better than raloxifene.

The authors arrived at their conclusions after finding 89 fair-to-good quality trials in which both SERMs reduced risk of invasive breast cancer w/tamoxifen getting the edge over raloxifene but at the cost of the above noted complications.  Of note, taking one of two SERMs did not reduce either cancer-specific nor all-cause mortality.  On the other hand, both medications lowered the rate of fractures.

So what should you do?  Start w/your family doc who should know your medical history & family history.  Then use one of several online calculators to determine your risk for breast cancer.  Consider genetic testing if your risk is high eneough.  And finally ask your doc about chemoprophylaxis vs prophylactic mastectomy if your genes demonstrate high enough risk.

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