- Aromatase inhibitors (AIs) were added to the list of recommended risk-reducing medications that clinicians can offer to postmenopausal women at increased risk for invasive estrogen receptor (ER)-positive breast cancer, provided they are at low risk for adverse medication effects, according to a new draft statement by the US Preventive Services Task Force (USPSTF).
Why this matters
- The draft recommendation adds a new medication class with a unique safety profile vs previously recommended tamoxifen and raloxifene.
- No preference is specified.
- AIs were found to decrease the incidence of invasive ER-positive breast cancer by 16 events for every 1000 women given the drugs (exemestane or anastrozole) over 5 years of use.
- AIs have small to moderate harms, including hot flashes, musculoskeletal pain, gastrointestinal symptoms, and possible stroke or fracture.
- The USPSTF draft does not specify a single cutoff for defining who is at increased risk for breast cancer, but notes that women with at least a 3% risk for breast cancer in the next 5 years are likely to have more benefit than harm.
- A detailed evidence synthesis accompanies the USPSTF draft recommendation.