New ASCO Guidelines Recommending Aromasin to Lower Risk of Breast Cancer in High-Risk Postmenopausal Women

On July 8th, 2013, The American Society of Clinical Oncology (ASCO) released new guidelines recommending the horomonal therapy medicine Aromasin to lower the breast cancer risk in postmenopausal women who are considered at high-risk of developing the disease. This is big news in the breast cancer world. What and why, you wonder?  Well, I thought that I’d take this opportunity to tell you a little bit about it.

First of all, let me back up and begin by describing what makes a person high risk:

• A personal history of invasive breast cancer,  ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS)or atypical hyperplasia. (My category!)
• A mutation (or a first-degree relative with a mutation) in the BRCA1 or BRCA2 gene
• A strong family history of breast cancer, such as a mother and/or sister diagnosed at age 40 or younger
• Radiation treatment to the chest area during childhood or young adulthood
• A mutation (or a first-degree relative with a mutation) in the TP53 or PTEN genes (These gene mutations can lead to Li-Fraumeni syndrome, Cowden syndrome or Bannayan-Riley-Ruvalcaba syndrome. People with one of these syndromes or who have a first-degree relative with one of these syndromes have an increased risk of breast cancer.)

Since 2007, research has indicated that certain drugs can be taken to reduce the risk of developing breast cancer in people who are at high risk. Currently, two drugs, Evista and tamoxifen are approved by the U.S. Food and Drug Administration (FDA) to be used as options to reduce the risk of developing breast cancer. Both Evista and tamoxifen are called selective estrogen receptor moderators, or SERMs. They work by depositing themselves in the breast cells’ estrogen receptors. The blocking action of estrogen limits cell growth. It’s a simplistic description, but I hope that it makes sense.

The drug Aromasin is a newbie. Though it hasn’t yet been approved by the FDA (an organization that moves at a turtle’s pace!), ASCO experts decided to recommend that it be discussed as a preventive medicine based on research showing that high-risk postmenopausal women who took Aromasin were 65% less likely to be diagnosed with breast cancer than women who took a placebo (sugar pill). That’s a pretty big Silver Lining don’tcha think?

Here’s how it works:  Aromasin is an aromatase inhibitor that works by stoping the production of estrogen in a woman’s body and starving estrogen-receptive breast cancer cells of the very fuel they need to grow.

The ASCO experts based the new guidelines on their review of research done between June 2007 and July 2012. Key recommendations in the guidelines are:

• Tamoxifen (20 mg per day for 5 years) should be discussed as an option to reduce the risk of estrogen-receptor-positive breast cancer with both premenopausal and postmenopausal women age 35 or older who have a higher-than-average risk of breast cancer. Tamoxifen isn’t recommended for women who have a history of blood clots, stroke, or heart attack. Pregnant women, women who may become pregnant, and nursing mothers shouldn’t take tamoxifen. Women who are taking hormone replacement therapy (HRT) also shouldn’t take tamoxifen.
• Evista (60 mg taken per day for 5 years) should be discussed as an option to reduce the risk of estrogen-receptor-positive breast cancer with postmenopausal women age 35 and older who have a higher-than-average risk of breast cancer. Evista shouldn’t be used to reduce risk in premenopausal women. Evista isn’t recommended for women who have a history of blood clots, stroke, or heart attack.
• Aromasin (25 mg per day for 5 years) should be discussed as an alternative to tamoxifen or Evista to reduce the risk of estrogen-receptor-positive breast cancer with postmenopausal women age 35 and older who have a higher-than-average risk of breast cancer. Aromasin shouldn’t be used to reduce risk in premenopausal women.

Unfortunately, you can’t get something for nothing. According to Breastcancer.org, tamoxifen, Evista, and Aromasin all may cause side effects, some of them severe. Hot flashes and night sweats are side effects of all three medicines, though they’re more common with tamoxifen and Evista. Joint pain is a more common side effect of Aromasin. Aromasin also may weaken bones and make women more likely to break a bone. All three medicines can sometimes cause dangerous blood clots in rare cases. This complication is more common with tamoxifen and Evista. UGH, I know.

The Silver Lining is that in addition to considering taking these drugs, lifestyle modifications play a big role in decreasing the risk of a diagnosis.  These include:

• Limiting or avoiding alcohol
• Maintaining a healthy weight
• Avoiding excessive sugar
• Exercising at as high intensity as possible
• Eating healthy, nutritious real (i.e., unprocessed) food.
• Not smoking…or if you are, puhhhhhlease stop!

Also, please please please do self breast exams, have regular checkups and beware of the signs and symptoms of breast cancer. These are huge things that we all can do to be an active, engaged participant in our own health care!

The bottom line is this: if you fall into the high risk category, please talk with your doctor about whether (or not!) one of these drugs is right for you.  The Silver Lining is that there are indeed options.

* You can read the guidelines on the Journal of Clinical Oncology website: “Use of Pharmacologic Interventions for Breast Cancer Risk Reduction: American Society of Clinical Oncology Clinical Practice Guideline”