The UK’s National Institute for Health and Care Excellence (NICE) has recommended a new drug to prevent breast cancer in families at high risk.
According to NICE, women whose close family members have had breast cancer, particularly at an early age may benefit from medicines to reduce their risk of developing the disease. New evidence demonstrated if 1,000 women at high risk of breast cancer took anastrozole for 5 years 35 cases of breast cancer would be prevented, compared to 21 if they took tamoxifen.
NICE recommends anastrozole is offered for 5 years to women at high risk of breast cancer unless they have severe osteoporosis. And clinicians should consider offering it to women at moderate risk of breast cancer.
The recommendations appear in the draft update of the familial breast cancer guideline out for consultation.
Professor Mark Baker, director of the centre for guidelines at NICE, said: “Our draft guideline update recommends the use of anastrozole as a first line treatment for postmenopausal women at high or medium risk of breast cancer who don’t have osteoporosis.
“The evidence examined by the committee suggests anastrozole will not only reduce the number of breast cancer cases in these women compared to tamoxifen, but it is also a more cost effective option.”
The draft guideline also recommends genetic testing for BRCA1 and BRAC2 mutations in women under 50 with triple negative breast cancer. Testing should only be offered if the woman does not have a family history of breast or ovarian cancer.
The draft guideline update is out for consultation until 29 December 2016.
Nicola Smith, senior health information officer at Cancer Research UK, is quoted in a Daily Mail report as saying: “Taking a pill to reduce the risk of breast cancer is an encouraging new option for post-menopausal women at high risk of the disease. For most women the side effects of anastrozole are likely to be less severe than those experienced with tamoxifen which also reduces breast cancer risk. It’s important for women to consult their doctor if they think they might be at high risk of breast cancer.”
The report says the drug works by stopping the action of an enzyme called aromatase. Found in fatty tissue, it makes the cancer-triggering hormone oestrogen. But anastrozole is only effective after the menopause because younger women produce large amounts of oestrogen from their ovaries, which the drug does not block. Women taking it are far less likely to suffer the side effects found with tamoxifen, including hot flushes, blood clots and thinning of the bones.
The report says charities fear GPs will be reluctant to prescribe anastrozole because, like tamoxifen, it has not been licensed for preventative use. This means GPs could be sued by women who suffer severe side effects. Baroness Delyth Morgan of Breast Cancer Now said: “That the most effective preventive drug for post-menopausal women at high risk of breast cancer has now been recommended for routine use is fantastic news. Studies have shown anastrozole cuts the risk of the disease in post-menopausal women by more than 50% in the first five years, and, crucially, it has fewer side effects than other preventive options such as tamoxifen and raloxifene. However – like tamoxifen – anastrozole is not licensed for this purpose, and we are concerned that patients will therefore not be able to access this treatment, despite this recommendation.”
Professor Tony Howell, scientific director of the charity Prevent Breast Cancer, said: “Anastrozole is a proven method of preventing breast cancer in post-menopausal women and it’s essential that GPs are given the appropriate tools and guidance so that they can offer patients the best course of preventative therapy. It’s important that women at high and moderate risk are educated on the options available to them and are given the correct support at the right time.”