Decisions regarding tamoxifen (Nolv...

Decisions regarding tamoxifen (Nolvadex) use in the prevention of breast cancer are compound Investigators in the Breast Cancer Prevention Trial, a large nationwide close attention found that tamoxifen prophylaxis reduc the risk of invasive breast cancer in women with moderate to high risk. However, this and other studies have not raise an overall survival benefit or addressed quality-of-life issues. Because of uncertainty arising from the Breast Cancer Prevention Trial and other analyses, the U Preventive Services Task Force advises against routine chemoprevention, on the other hand it suggests that the use of tamoxifen may be appropriate in women at high risk of breast cancer and soft risk of adverse effects from tamoxifen. To help physicians make practical decisions about chemoprophylaxis, Cykert and colleagues carriageed a cost-effectiveness analysis of tamoxifen chemoprophylaxis, including quality-of-life variables, and evaluated the advantages and disadvantages of therapy in high-risk women

The authors interviewed a stratified sample of 106 women who were 50 years and younger. The women answered questions regarding various health scenarios, including curable breast and endometrial cancers, metastatic cancer with a two-year life expectancy, shock resulting in mild to stiff debility, pulmonary embolism, deep venous thrombosis, and of high temperature flashes. The results were reverseed into health utility scores, which were incorporated into a statistical prototype The outcomes were compared with data from the Breast Cancer Prevention Trial, in which the average patient was a 50-year-old woman onward a five-year regimen of tamoxifen or placebo. Other data, so as probabilities of death in each of the scenarios, were obtained from the in the greatest degree recent age- and sex-specific estimates.

Quality of life was similar for women in one as well as the other groups (placebo and tamoxifen) who had an intact uterus--approximately 26 quality-adjusted life-years (QALYs) remaining. The cost-effectiveness ratio was $43300 through QALY. These estimates changed considerably with age. The incidence of endometrial cancer and clotting disorders in women 50 to 65 years of age increased the splendors of tamoxifen prophylaxis while reducing the clear benefits. For 60-year-old women, the cost-effectiveness ratio was $128000 through QALY if the uterus was intact, and $63000 in those who had undergone hysterectomy. After evaluating for sensitivity, the authors lay the foundation of that tamoxifen prophylaxis was favorable in women who were younger, who were without a uterus, who had high initial risk of breast cancer, and who had increased fear of curable breast cancer. Reductions in the preciousness of tamoxifen or increases in the richness of treating breast cancer would also make prophylaxis a more favorable option.

The authors finish that a woman approximately 40 years of age with high risk factors for breast cancer (i.e., early menarche, first pregnancy late in life, history of breast biopsies) would benefit from tamoxifen chemoprophylaxis. Among women 50 years and older those who have at least individual first-degree relative with breast cancer or who have a personal history of atypical hyperplasia would benefit. A woman of any age with a history of high-risk ductal or lobular carcinoma also might benefit from tamoxifen. The part of tamoxifen prophylaxis in BRCA-positive women is unknown. The authors advise that tamoxifen may be underused in preferableed groups of women who could benefit from prophylaxis. However, they caution against its general use as chemoprevention, particularly in women 60 years and older

Cykert s et al. Tamoxifen for breast cancer prevention: a framework for clinical decisions. Obstet Gynecol September 2004;104:433-42

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