Treatment
Table 2. Summary of All Recommendations
Agent Recommendations
Strength of
Recommendation
and Strength of
Evidence
Exemestane • Should be discussed as an alternative to tamoxifen
and/or raloxifene to reduce the risk of invasive breast
cancer, specifically estrogen (ER)-positive BC, in
postmenopausal women ≥35 years of age with a 5-year
projected absolute BC risk ≥1.66% or with LCIS or
atypical hyperplasia.
• Should NOT be used for BC risk reduction in
premenopausal women.
• Discussions with patients and health care providers
should include both the risks and benefits of
exemestane in the preventive setting
• DOSAGE: 25 mg/d orally for 5 years.
Moderate,
evidence-based
recommendation
Strength of
evidence:
Moderate
evidence-based on
1 RCT with low
risk of bias
Anastrozole • Anastrozole (1 mg/day orally for 5 years) should be
discussed as an alternative to tamoxifen, raloxifene,
or exemestane to reduce the risk of invasive BC
in postmenopausal women at increased risk of
developing BC.
• Women most likely to benefit are those with one
of more of the following : a diagnosis of atypical
(ductal or lobular) hyperplasia or lobular carcinoma
in situ, an estimated 5-year risk (NCI Breast Cancer
Risk Assessment Tool [BCRAT]) of at least 3%, a
10-year risk (IBIS /Tyrer Cuzick Risk Calculator) of
at least 5%, or a relative risk of at least four times the
population risk for age group if 40–44, or two times
that for age group if 45–69.
• Clinicians should NOT prescribe anastrozole,
exemestane or raloxifene for breast cancer risk
reduction in premenopausal women.
• Discussions between patients and health care
providers should include both the benefits and risks of
anastrozole along with the other approved drugs for
risk reduction based on menopausal status.
Evidence based,
benefits outweigh
harms; Evidence
quality: high
Strength of
recommendation:
Strong-based on 1
RCT with low risk
of bias
(cont'd)
