**7. References**

162 Cancer of the Uterine Endometrium – Advances and Controversies

For non-Hispanic white women age 50 years or older with a uterus, raloxifene displays a better benefit/risk profile than tamoxifen overall (Freedman et al. 2011). For tamoxifen, women age 50 to 59 years with a 5-year risk of invasive breast cancer of 4.5% to 6.5% showed moderate evidence of net positive benefit, and women with risk of 7.0% or higher showed strong evidence. For women age 50 to 59 years with a 5-year risk of invasive breast cancer less than 4.0%, the risks outweighed the benefits. The risks outweighed the benefits for women age 60 years or older, regardless of IBC risk. In contrast, for raloxifene, there was strong evidence that benefits outweighed risks, compared with placebo, for women age 50 to 59 years with a 5-year breast cancer risk of 3.5% or higher and for women age 60 to 69 years with an risk of 6.5% risk or higher. There was moderate evidence of a net benefit for women age 50 to 59 years with a 5-year risk of 2.0% to 3.0%, women age 60 to 69 years with a 5-year risk of 3.0% to 6.0%, and women age 70 to 79 years with a 5-year IBC risk of 4.0% or higher. For postmenopausal black and Hispanic women with a uterus, raloxifene also displayed a better benefit/risk profile than tamoxifen and in a similar pattern to that for whites. Net benefit indices tended to be larger in Hispanic women and smaller in black

**6. American Society of Clinical Oncology (ASCO ) recommendations for** 

In premenopausal women, tamoxifen for 5 years reduces the risk of breast cancer for at least 10 years, particularly estrogen receptor (ER) –positive invasive tumors. Women ≤ 50 years of age experience fewer serious side effects. Vascular and vasomotor events do not persist post-treatment across all ages. In postmenopausal women, raloxifene and tamoxifen reduce the risk of ER-positive invasive BC with equal efficacy. Raloxifene is associated with a lower risk of thromboembolic disease, benign and malignant uterine conditions, and cataracts than tamoxifen in postmenopausal women. No evidence exists establishing whether a reduction in risk of breast cancer from either agent translates into

**6.1 2009 Recommendation for the Use of tamoxifen to reduce the risk of developing** 

Five years of tamoxifen (20 mg/d) may be offered to women at increased risk of breast cancer to reduce their risk of estrogen receptor (ER) –positive invasive breast cancers for up to 10 years (Visvanathan et al. 2009). Eligible women include those with a 5-year projected breast cancer risk ≥ 1.66% (according to the National Cancer Institute [NCI] Breast Cancer Risk Assessment Tool based on the Gail model23 —available at http://www.cancer.gov/bcrisktool) or women with LCIS. The benefit of taking tamoxifen for more than 5 years is unknown. The greatest clinical benefit and the fewest side effects were derived from the use of tamoxifen in younger (premenopausal) women 35 to 50 years of age who are unlikely to experience thromboembolic sequelae or uterine cancer, women without a uterus, and women at high risk of breast cancer (Newman and Vogel 2007). Vascular and vasomotor side effects were observed to decline post-treatment across all ages. Tamoxifen is not recommended in women with a prior history of deep vein thrombosis (DVT), pulmonary embolus (PE), stroke, or transient ischemic attack. Combined use of tamoxifen for breast cancer prevention and hormone therapy (HT) is currently not

women than in white women, however.

**breast cancer risk reduction** 

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