Treatment
Table 2. Summary of All Recommendations
Agent Recommendations
Strength of
Recommendation
and Strength of
Evidence
Tamoxifen • Should be discussed as an option to reduce the risk of
invasive BC, specifically estrogen (ER)-positive breast
cancer, in premenopausal women who are ≥35 years of
age with a 5-year projected absolute BC risk ≥1.66%
or with lobular carcinoma in situ (LCIS). Risk
reduction benefit continue for at least 10 years.
• Is NOT recommended for use in women with a
history of deep vein thrombosis, pulmonary embolus,
stroke, transient ischemic attack, or during prolonged
immobilization.
• Is NOT recommended for women who are pregnant,
women who may become pregnant, or nursing
mothers.
• Is NOT recommended in combination with hormone
therapy.
• Follow-up should include a timely work-up of
abnormal vaginal bleeding.
• Discussions with patients and health care providers
should include both the risks and benefits of
tamoxifen in the preventive setting
• DOSAGE: 20 mg/d orally for 5 years.
Strong,
evidence-based
recommendation
Strength of
evidence: Strong
evidence-based on
5 RCTs with low
risk of bias
Raloxifene • Should be discussed as an option to reduce the risk
of invasive BC, specifically estrogen (ER)-positive
breast cancer, in postmenopausal women who are ≥35
years of age with a 5-year projected absolute BC risk
≥1.66% or with LCIS.
• May be used longer than 5 years in women with
osteoporosis, in whom BC risk reduction is a
secondary benefit.
• Should NOT be used for BC risk reduction in
premenopausal women.
• Is NOT recommended for use in women with a
history of deep vein thrombosis, pulmonary embolus,
stroke, or transient ischemic attack, or during
prolonged immobilization.
• Discussions with patients and health care providers
should include both the risks and benefits of
raloxifene in the preventive setting.
• DOSAGE: 60 mg/d orally for 5 years.
Strong,
evidence-based
recommendation
Strength of
evidence: Strong
evidence-based on
4 RCTs with low
risk of bias
