When should tamoxifen be offered for breast cancer prevention?

PREVIEW

With more than 20 years' worth of clinical trials and safety data, tamoxifen is one of the most intensely studied cancer interventions, and it has recently been evaluated for breast cancer prevention. But as with other drugs, its use is not without adverse effects. Thus, an important question for primary care physicians is, which patients are candidates for the agent? The authors contend that physicians should offer information about the risks and benefits of tamoxifen therapy to all high-risk women or refer them to physicians who can provide these facts. In this article, the authors describe how to determine patients' risk. They also summarize findings of studies of tamoxifen and review the limited information available on use of other antiestrogens for reducing the risk of breast cancer.