ASCO updates guidelines for breast cancer risk reduction

  • J Clin Oncol
  • 5 Sep 2019

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • The American Society of Clinical Oncology (ASCO) updates its guidelines on endocrine therapy for breast cancer risk reduction within a week of a similar update by the US Preventive Services Task Force (USPSTF).
  • ASCO adds anastrozole (1 mg/day) to the list of medication options for postmenopausal women.

Why this matters

  • ASCO's recommendations were last issued in 2013, when they first added the aromatase inhibitor (AI) exemestane; USPSTF did not add any AIs until 2019.
  • ASCO and USPSTF both recommend AIs, raloxifene, or tamoxifen expressly for postmenopausal women; tamoxifen is the only option for premenopausal women.
  • ASCO recommendations offer more detail regarding the adverse effect of AIs on bone health.

Key points

  • Before prescribing AIs, ASCO recommends that clinicians evaluate patients for fracture risk and measure their bone mineral density (BMD).
  • Clinicians should be cautious about prescribing anastrozole in postmenopausal women with moderate BMD loss.
  • If clinicians do prescribe anastrozole for this subset of women, they should consider co-prescribing bone-protective agents such as bisphosphonates and receptor activator of nuclear factor κ-B ligand (RANKL) inhibitors.
  • Anastrozole should not be used in women with a history of osteoporosis and/or severe bone loss.
  • Tamoxifen and raloxifene are alternative breast cancer-reducing medications that do not lower BMD.