Menopause : the journal of the North American Menopause Society
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Decision making about menopausal therapies is complex because of the number of clinical factors that must be considered. Menopausal hormone therapy can relieve the vasomotor symptoms of menopause, but the most common preparation, combination estrogen and progesterone, increases the risk of breast cancer. Both tamoxifen and raloxifene can reduce the risk of developing invasive breast cancer, but the adverse effects of these drugs differ substantially. ⋯ Any woman with a family history of breast cancer should be assessed as to whether she is likely to carry a BRCA mutation and referred for genetic counseling and possible genetic testing. Decisions about treatment options should be based on the presence or absence of bothersome vasomotor symptoms, an intact uterus, and risk factors for cardiovascular disease. A simple algorithm is presented to streamline identification and management of menopausal women at high risk for breast cancer.
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The evidence regarding the risks, benefits, and quality of life impact of tamoxifen and raloxifene for prevention of breast cancer in postmenopausal women was reviewed. Five placebo-controlled trials were identified, four with tamoxifen and one with raloxifene. The individual placebo-controlled trials of tamoxifen for breast cancer prevention vary in size and risk status of the women who participated. ⋯ The toxicity profiles for the two drugs were similar, with the exception of fewer hysterectomies, pulmonary emboli, and deep vein thrombosis in the raloxifene-treated group. There are now two effective Selective estrogen-receptor modulators available for use in postmenopausal women to reduce the risk of breast cancer. Women at high risk of breast cancer should be offered this therapy, and if one drug is not well tolerated, the other should be considered.