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continued:

Breast cancer chemoprevention: Medicines that reduce breast cancer risk

Aromatase inhibitors

Aromatase inhibitors aren't FDA approved for breast cancer chemoprevention, but they are the subject of much ongoing research.

How they work
Aromatase inhibitors are a class of medicines that reduce the amount of estrogen in your body, depriving breast cancer cells of the fuel they need to grow and thrive. Three aromatase inhibitors are currently used in the treatment of women with breast cancer: anastrozole (Arimidex), exemestane (Aromasin) and letrozole (Femara). These medications are used after breast cancer surgery to prevent breast cancer from returning (recurring).

Who they're for
Aromatase inhibitors have been studied and shown to be effective in postmenopausal women to treat breast cancer and to prevent breast cancer recurrence. Aromatase inhibitors are not intended for preventing breast cancer recurrence in women who still have menstrual cycles.

Common side effects
Common side effects of aromatase inhibitors include:

  • Hot flashes
  • Vaginal dryness
  • Joint and muscle pain
  • Headache

Risks
Aromatase inhibitors raise the risk of:

  • Broken bones (fractures)
  • Osteoporosis

Because aromatase inhibitors are a newer class of medications, not much is yet known about long-term health risks, such as heart disease. As more results from research studies become available, doctors will have a better idea of these long-term health implications, as well as of the drugs’ effectiveness in breast cancer chemoprevention.

A word about aspirin

Several studies have looked into the effects of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) on breast cancer risk. NSAIDs include many common over-the-counter painkillers, such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve).

Study results are mixed. Some research has found that women who had breast cancer and who regularly take aspirin or other NSAIDs have a slightly decreased risk of breast cancer recurrence. But other studies haven't shown a significant association between breast cancer risk and NSAIDs.

It remains unknown whether aspirin and other NSAIDs help protect against breast cancer, and if so, exactly how they work to do so. Because some NSAIDs, such as celecoxib (Celebrex) and naproxen sodium (Aleve), may increase the risk of heart attack and stroke, talk with your doctor to weigh the potential benefits versus the risks of taking an NSAID in your situation. 

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References
  1. Medicines to reduce breast cancer risk. American Cancer Society. http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Tamoxifen_and_Raloxifene_Questions_and_Answers_5.asp?sitearea. Accessed Dec. 5, 2008.
  2. FDA approves new uses for Evista (raloxifene hydrochloride). Food and Drug Administration Center for Drug Evaluation and Research. http://www.fda.gov/cder/Offices/OODP/whatsnew/raloxifene.htm. Accessed Dec. 8, 2008.
  3. Pruthi S, et al. A multidisciplinary approach to the management of breast cancer, part 1: Prevention and diagnosis. Mayo Clinic Proceedings. 2007;82:999.
  4. Land SR, et al. Patient-reported symptoms and quality of life during treatment with tamoxifen or raloxifene for breast cancer prevention: The NSABP study of tamoxifen and raloxifene (STAR) P-2 trial. Journal of the American Medical Association. 2006;295:2742.
  5. The study of tamoxifen and raloxifene (STAR): Questions and answers. National Cancer Institute. http://www.cancer.gov/Templates/doc.aspx?viewid=0123E12E-CCD6-47BC-9964-D5DD6CB0399E. Accessed Dec. 5, 2008.
  6. Harris RE, et al. Breast cancer and nonsteroidal anti-inflammatory drugs: Prospective results from the Women's Health Initiative. Cancer Research. 2003;63:6096.
  7. Terry MB, et al. Association of frequency and duration of aspirin use and hormone receptor status with breast cancer risk. Journal of the American Medical Association. 2004;291:2433.
  8. Agrawal A, et al. NSAIDs and breast cancer: A possible prevention and treatment strategy. International Journal of Clinical Practice. 2008;62:444.
  9. Chan K, et al. Chemoprevention of breast cancer for women at high risk. Seminars in Oncology. 2006;33:642.
  10. Mosca L, et al. Effect of raloxifene on stroke and venous thromboembolism according to subgroups in postmenopausal women at increased risk of coronary heart disease. Stroke. In press. Accessed Dec. 12, 2008.

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Jan. 21, 2009

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