Download or read book Medication Use for the Risk Reduction of Primary Breast Cancer in Women written by Heidi D. Nelson and published by . This book was released on 2019 with total page 213 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: Medications to reduce breast cancer risk are an effective prevention intervention for women at increased risk, although medications also cause adverse effects. PURPOSE: To update the 2013 U.S. Preventive Services Task Force (USPSTF) systematic review on the use of medications to reduce the risk of primary breast cancer. DATA SOURCES: Searches included the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, EMBASE, and MEDLINE (January 1, 2013 to February 1, 2019); and manual review of reference lists. Studies published before 2013 were identified from prior systematic reviews for the USPSTF. STUDY SELECTION: Discriminatory accuracy studies of breast cancer risk assessment methods; double-blind, placebo-controlled or head-to-head randomized controlled trials (RCT) of tamoxifen, raloxifene, and aromatase inhibitors for primary prevention of breast cancer that enrolled women without preexisting breast cancer; and RCTs and observational studies of harms of medications. DATA EXTRACTION: One investigator abstracted data on study methods; setting; population characteristics; eligibility criteria; interventions; numbers enrolled and lost to followup; method of outcome ascertainment; and results for each outcome and a second investigator checked abstractions for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. DATA SYNTHESIS (RESULTS): Eighteen risk models evaluated in 25 studies had generally low discriminatory accuracy in predicting the probability of breast cancer in an individual (c-statistics 0.55 to 0.65). Most models performed only slightly better than age alone as a risk predictor. No studies evaluated optimal ages or frequencies of risk assessment. In placebo-controlled trials, tamoxifen (risk ratio [RR] 0.69; 95% confidence interval [CI], 0.59 to 0.84; 7 fewer cases per 1000 women over 5 years of use [95% CI, 4 to 12]; 4 trials), raloxifene (RR 0.44; 95% CI, 0.24 to 0.80; 9 fewer cases [95% CI, 3 to 15]; 2 trials), and the aromatase inhibitors exemestane and anastrozole (RR 0.45; 95% CI, 0.26 to 0.70; 16 fewer cases [95% CI, 8 to 24]; 2 trials) reduced invasive breast cancer. Risk for invasive breast cancer was higher for raloxifene than tamoxifen in the Study of Tamoxifen And Raloxifene (STAR) head-to-head trial (RR, 1.24; 95% CI, 1.05 to 1.47) after long-term followup. Effects did not differ by age of initiation or duration of use (3 to 5 years), although these effects were not directly compared. Risk reduction persisted at least 8 years after discontinuation in tamoxifen trials with long-term followup. All medications reduced estrogen receptor positive, but not estrogen receptor negative invasive breast cancer; tamoxifen reduced noninvasive cancer in two trials; and breast-cancer specific and all-cause mortality were not reduced. In placebo-controlled trials, raloxifene (RR 0.61; 95% CI, 0.53 to 0.73; 2 trials) reduced vertebral fractures; tamoxifen reduced nonvertebral fractures in the National Surgical Adjuvant Breast and Bowel Project (NSABP P-1) trial (RR 0.66; 95% CI, 0.45 to 0.98); while the aromatase inhibitors had no effect on fractures. Tamoxifen and raloxifene had similar effects on reducing fractures at multiple vertebral and nonvertebral sites in the STAR head-to-head trial. In placebo-controlled trials, tamoxifen (RR 1.93; 95% CI, 1.33 to 2.68; 4 trials) and raloxifene (RR 1.56; 95% CI, 1.11 to 2.60; 2 trials) increased thromboembolic events, while aromatase inhibitors did not. Raloxifene caused fewer thromboembolic events (RR 0.75; 95% CI, 0.60 to 0.93) than tamoxifen in the STAR head-to-head trial. Tamoxifen, raloxifene, and aromatase inhibitors did not increase coronary heart disease events or strokes. In placebo-controlled trials, tamoxifen increased endometrial cancer (RR 2.25; 95% CI, 1.17 to 4.41; 3 trials), while raloxifene and aromatase inhibitors did not. In the STAR head-to-head trial, raloxifene caused fewer cases of endometrial cancer (RR 0.55; 95% CI, 0.36 to 0.83) and endometrial hyperplasia (RR 0.19; 95% CI, 0.12 to 0.29), and fewer hysterectomies (RR 0.45; 95% CI, 0.37 to 0.54) than tamoxifen. Tamoxifen increased cataracts (RR 1.22; 95% CI, 1.08 to 1.48; 3 trials) and cataract surgery compared with placebo, while raloxifene and aromatase inhibitors did not. Risks for thromboembolic events and endometrial cancer with tamoxifen were higher for older compared with younger women and returned to normal after discontinuation. All medications caused adverse effects, such as vasomotor or musculoskeletal symptoms, that varied by medication. Risks for invasive cancer were generally reduced in all population subgroups evaluated based on menopausal status (pre and postmenopausal); family history of breast cancer; body mass index categories; modified Gail model risk categories; and age at menarche, parity, or age at first live birth, although results varied. Tamoxifen and anastrozole had larger effects in reducing invasive breast cancer in women with previous breast lesions (lobular carcinoma in situ, atypical ductal hyperplasia, or atypical lobular hyperplasia). LIMITATIONS: Trials were limited by clinical heterogeneity related to different medications, exposure durations, eligibility criteria, adherence, and ascertainment of outcomes. No trials compared timing and duration directly. Long-term followup data were lacking from most trials, and followup was particularly short for the aromatase inhibitors. Trials were not designed for subgroup comparisons and analysis of differences may be underpowered. CONCLUSIONS: Tamoxifen, raloxifene, and the aromatase inhibitors exemestane and anastrozole reduce invasive breast cancer in women without preexisting breast cancer, but also cause adverse effects that vary by medication. Tamoxifen and raloxifene increase thromboembolic events and tamoxifen increases endometrial cancer and cataracts. Identifying candidates for therapy is complicated by risk stratification methods that demonstrate low accuracy.
Download or read book Comparative Effectiveness of Medications to Reduce Risk of Primary Breast Cancer in Women written by U. S. Department of Health and Human Services and published by Createspace Independent Pub. This book was released on 2013-05-14 with total page 238 pages. Available in PDF, EPUB and Kindle. Book excerpt: Breast cancer is the most frequently diagnosed noncutaneous cancer and the second leading cause of cancer death after lung cancer among women in the United States. In 2008, an estimated 182,460 cases of invasive breast cancer and 67,770 cases of in situ breast cancer were diagnosed, and 40,480 women died of breast cancer in the United States. Recent clinical trials have demonstrated the efficacy of three medications—tamoxifen citrate, raloxifene, and tibolone—to reduce the risk of invasive breast cancer in women without pre-existing cancer. This therapy is sometimes referred to as “chemoprevention” in the literature, although this is not a fully accurate representation of the intervention. Tamoxifen and raloxifene are approved by the U.S. Food and Drug Administration for this indication and tibolone is not. Raloxifene is approved for use by postmenopausal women only. Current clinical recommendations, including those from the U.S. Preventive Services Task Force issued in 2002, support tamoxifen use for primary breast cancer prevention in women considered at high risk for breast cancer by the Gail model or other criteria and low risk for adverse events. However, use of risk-reducing medications for breast cancer is believed to be low in the United States. The purpose of this review is to evaluate the comparative effectiveness of tamoxifen citrate, raloxifene, and tibolone to reduce the risk of primary breast cancer; assess the nature and magnitude of harms; and examine how benefits and harms vary by age, breast cancer risk status, and other factors. The review was originally entitled “Comparative Effectiveness of Chemotherapy Agents in the Prevention of Primary Breast Cancer in Women.” Peer review comments suggested that the terms “chemotherapy” and “prevention” were misnomers. The term “medications to reduce risk” is a better representation of the intervention and therefore, all references to “chemoprevention” are edited, including the key questions and report title. The review also examines issues related to clinical effectiveness, such as patient choice, concordance, adherence, and persistence of use, and evaluates methods to appropriately select patients for risk-reducing medications for clinical applications. The target population includes women without pre-existing breast cancer, noninvasive breast cancer, or precursor conditions who are not known carriers of breast cancer susceptibility mutations (BRCA1, BRCA2, or others). Key questions addressed include: Key Question 1. In adult women without pre-existing breast cancer, what is the comparative effectiveness of selective estrogen receptor modulators (SERMs) tamoxifen citrate and raloxifene, and the selective tissue estrogenic activity regulator (STEAR) tibolone, when used to reduce risk for primary breast cancer on improving short-term and long-term outcomes including invasive breast cancer, noninvasive breast cancer, including ductal carcinoma in situ (DCIS), breast cancer mortality, all-cause mortality, and osteoporotic fractures? Key Question 2. What is the evidence for harms of tamoxifen citrate, raloxifene, and tibolone when used to reduce risk for primary breast cancer? Key Question 3. How do outcomes for tamoxifen citrate, raloxifene, and tibolone when used for primary prevention of breast cancer vary by heterogeneity in subpopulations? Key Question 4. What is the evidence that harms or secondary potential benefits listed above affect treatment choice, concordance, adherence, and persistence to treatment with tamoxifen citrate, raloxifene, and tibolone when used for primary prevention of breast cancer? Key Question 5. What methods, such as clinical risk-assessment models, have been used to identify women who could benefit from medications to reduce risk of breast cancer?
Download or read book Comparative Effectiveness of Medications to Reduce Risk of Primary Breast Cancer in Women written by H. D. Nelson and published by . This book was released on 2009 with total page 8 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Reducing Breast Cancer Risk with Drugs written by and published by Am Cncl on Science, Health. This book was released on with total page 22 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Chemoprevention for Primary Breast Cancer Risk Reduction for Women at High Risk of Breast Cancer written by Linda M. Kottmann and published by . This book was released on 2016 with total page 242 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book The Breast written by K. I. Bland and published by Saunders. This book was released on 2009 with total page 822 pages. Available in PDF, EPUB and Kindle. Book excerpt: Offering the most comprehensive, up-to-date information on the diagnosis and management of, and rehabilitation following, surgery for benign and malignant diseases of the breast, this surgical reference is now in a new edition available in both print and online for easy, convenient access to the absolute latest advances.
Download or read book Holland Frei Cancer Medicine written by Robert C. Bast, Jr. and published by John Wiley & Sons. This book was released on 2017-03-10 with total page 2004 pages. Available in PDF, EPUB and Kindle. Book excerpt: Holland-Frei Cancer Medicine, Ninth Edition, offers a balanced view of the most current knowledge of cancer science and clinical oncology practice. This all-new edition is the consummate reference source for medical oncologists, radiation oncologists, internists, surgical oncologists, and others who treat cancer patients. A translational perspective throughout, integrating cancer biology with cancer management providing an in depth understanding of the disease An emphasis on multidisciplinary, research-driven patient care to improve outcomes and optimal use of all appropriate therapies Cutting-edge coverage of personalized cancer care, including molecular diagnostics and therapeutics Concise, readable, clinically relevant text with algorithms, guidelines and insight into the use of both conventional and novel drugs Includes free access to the Wiley Digital Edition providing search across the book, the full reference list with web links, illustrations and photographs, and post-publication updates
Download or read book Adjuvant Therapy for Breast Cancer written by Monica Castiglione and published by Springer Science & Business Media. This book was released on 2009-07-11 with total page 483 pages. Available in PDF, EPUB and Kindle. Book excerpt: Adjuvant treatment is administered prior to or as follow up to surgical procedures for breast cancer. Proven success in using medical therapies allowing for breast conserving procedures or reducing risk of occurrence. Although there has been much progress towards a cure, including the introduction of new targeted therapies, metastasizing cancer remains highly incurable.
Download or read book Diseases of the Breast written by Jay R. Harris and published by Lippincott Williams & Wilkins. This book was released on 2012-03-28 with total page 3432 pages. Available in PDF, EPUB and Kindle. Book excerpt: Completely revised and updated, and now in full color throughout, the Fourth Edition of this definitive reference is a must for all clinicians who treat breast diseases. Leading experts summarize the current knowledge of breast diseases, including their clinical features, management, underlying biologies, and epidemiologies. In addition to complete coverage of malignant breast diseases, benign diseases are discussed in relation to subsequent breast cancer development. The book reviews all major clinical trials and summarizes the information they provide on early detection and management of breast cancer. Close attention is also given to the increasing importance of molecular biology and genetics in this field. This edition features more than thirty new contributors, fourteen new or completely rewritten chapters, and more clinically oriented chapters. A companion Website will offer the fully searchable text and an image bank. Also included with this edition is the Anatomical Chart Company's Breast Anatomy and Disorders Pocket Guide. This durable, portable folding pocket guide provides a visual and textual overview of breast anatomy, disorders, and breast self-examination. With a write-on, wipe-off laminated surface, this guide is perfect for the on-the-go practitioner to show patients, caregivers, and families.
Download or read book Chemo Prevention Treatment for Women with High Risk to Develop Breast Cancer written by Barbara Viana Machado Feitosa and published by . This book was released on 2016 with total page 50 pages. Available in PDF, EPUB and Kindle. Book excerpt: Recent studies and clinical trials, such Breast Cancer Prevention Trial (BCPT), have shown a great reduction in the risk of developing invasive breast cancer among high-risk women by taking specific drugs, like tamoxifen and raloxifene. Despite the significant reduction in breast cancer risk, which is approximately the same risk reduction as seen with bilateral prophylactic mastectomies, many women are not currently opting to take the anti-estrogen medication for breast cancer prevention. The most common reasons why patients are not opting to take the preventive therapy are that patients are more likely to accept preventive services if recommended by their physician, but that doesn't happen since they are not sufficiently trained in risk/benefit analysis. Patients also can experience fear and an overestimation of the side effects. A common perception also afflicting patients is that preventive therapy will not substantially reduce risk of developing breast cancer. Finally, the risk of breast cancer is not associated with a clinical sign or symptom. Therefore, the goal of this project is to simulate and compare the intake of both medicines and then compare with placebo, when no medicine is taken. The result will be in terms of Quality Adjusted Life Years (QALY), a generic measure of disease burden, including both the quality and the quantity of life lived. In the future, studies like this can support the development of an online decision making tool for patients' own evaluation on whether to take or not to take the medicine. It is expected that more knowledge and studies will eventually increase the awareness among female patients prescribing chemoprevention therapy.
Download or read book Comparative Effectiveness of Medications To Reduce Risk of Primary Breast Cancer in Women written by and published by . This book was released on 2009 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Essentials of Breast Surgery A Volume in the Surgical Foundations Series E Book written by Michael S. Sabel and published by Elsevier Health Sciences. This book was released on 2009-04-23 with total page 360 pages. Available in PDF, EPUB and Kindle. Book excerpt: This new volume in the Surgical Foundations series delivers need-to-know, current information in breast surgery in an exceptionally economical and user-friendly format. Coverage encompasses everything from anatomy and physiology, evaluation of breast symptoms...to discussions of breast cancer risk and management of breast cancer, equipping you to face any challenge with confidence. Whether reviewing key material in preparation for a procedure or studying for the boards, this is an invaluable resource in training and practice. Presents coverage that encompasses anatomy and physiology, evaluation of breast symptoms, breast cancer risk, and management of breast cancer to equip you to face any challenge with confidence. Addresses hot topics including gynecomastia, neoadjuvant therapy, management of ductal carcinoma in situ and Paget’s disease, risk assessment and genetic testing, breast MRI, partial breast irradiation, microarray analysis, and targeted therapies...providing you with a current perspective on this fast changing field. Begins each chapter with a bulleted list of key points, and presents crucial facts in boxes, to help facilitate review. Features abundant illustrations, photographs, and tables that clarify complex concepts. Follows a concise, logical, and consistent organization that makes the material easy to review.
Download or read book Comparative Effectiveness of Medications to Reduce Risk of Primary Breast Cancer in Women written by and published by . This book was released on 2009 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Future Research Needs to Reduce the Risk of Primary Breast Cancer in Women written by and published by . This book was released on 2010 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: The 2009 comparative effectiveness review (CER) on the effectiveness of medications to reduce the risk of primary breast cancer in women without preexisting cancer demonstrated the efficacy of two SERMs, tamoxifen citrate (RR, 0.70; 95% CI, 0.59 to 0.82; 4 trials) and raloxifene (RR, 0.44; CI, 0.27 to 0.71; 2 trials). However, the CER also outlined many adverse effects and unknowns about the medications. The objective of this pilot project was to engage stakeholders to develop and prioritize a list of research questions to address the research gaps related to the CER. First, the goal was to provide sufficient detail--including population, intervention, comparator, and outcome (PICO)--for researchers and funders to use in the development of research proposals and solicitations, respectively. Second, this project was intended to identify a feasible and effective approach to identify and prioritize future research from systematic reviews in general.
Download or read book Cancer in the Elderly written by Carrie P. Hunter and published by CRC Press. This book was released on 2000-03-01 with total page 591 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book presents comprehensive assessment and up-to-date discussion of the epidemiology, prevention, and treatment of cancer in the elderly, highlighting the growing demands of the disease, its biology, individual susceptibility, the impact of state-of-the-art and emerging therapies on reducing morbidity, and decision making processes. Describ
Download or read book Ongoing Data from the Breast Cancer Prevention Trials Opportunity for Breast Cancer Risk Reduction written by Ravenna Ravenna Press and published by . This book was released on 2016-02-13 with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt: Selective estrogen receptor modulators (SERMs) reduce the risk of recurrence of invasive breast cancer and the incidence of first breast cancers in women who are at increased risk. Multiple, randomized clinical trials have shown both the efficacy and safety of SERMs in reducing the risk of breast cancer. Long-term follow-up as long as 20 years in the randomized trials shows persistent efficacy with acceptable safety. Hormone replacement therapy given concurrently with tamoxifen abrogates its preventive effect, but women with atypical hyperplasia derive particular benefit from SERM therapy. Aromatase inhibitors also reduce the risk of developing invasive breast cancer, but the experience with them for risk reduction is limited to few trials. National organizations have made recommendations to use SERMs and aromatase inhibitors to reduce the risk of breast cancer in high-risk women and additional efforts should be made to increase their use in clinical practice, where the number of women needed to treat to prevent one case of breast cancer conforms to accepted standards of preventive medicine.
Download or read book Treatment of the Postmenopausal Woman written by Rogerio A. Lobo and published by Elsevier. This book was released on 2007-06-05 with total page 902 pages. Available in PDF, EPUB and Kindle. Book excerpt: For anyone who treats postmenopausal women, this latest edition of Rogerio Lobo's classic work combines the best from two well-known references: Menopause, and the second edition of Treatment of the Postmenopausal Woman. By adding significant discussions of the basic science behind menopause, it is possible to objectively assess the clinical value and limitations of current approaches to treatment and provide a basis and rationale for strategies that will result in better individualized and specialized care. Not only does the third edition discuss diagnosis and treatment of menopause but it covers biological, anatomical, physiological, pathobiological, and pharmacological aspects as well bringing together, in one source, all of the information needed to understand and treat postmenopausal conditions. Over 50% new material representing the vast amount of information available since the Women's Health Initiative (WHI) clinical trials were completed making this the most up-to-date reference on postmenopausal women Includes several new sections on comparisons between clinical trials and observational data, urology, and pelvic support Each section is preceded by a preface to put the area into context with many chapters having suggested treatment regimens
