Tamoxifen and raloxifene are the only two drugs FDA-approved for breast cancer risk reduction in women at higher risk.
You may also hear the term “chemoprevention” to describe these drugs. Please note, these drugs are not chemotherapy drugs.
Tamoxifen is a hormone therapy drug used to both treat and prevent breast cancer. Raloxifene is only used to lower the risk of breast cancer, not to treat it.
Both tamoxifen and raloxifene are taken in pill form.
Both tamoxifen and raloxifene can lower the risk of :
Tamoxifen and raloxifene only reduce the risk of estrogen receptor-positive breast cancers. Neither drug reduces the risk of estrogen receptor-negative cancers .
Tamoxifen is more effective than raloxifene in lowering breast cancer risk. However, raloxifene has fewer harmful side effects than tamoxifen (see table below) . This makes raloxifene a better choice for some women.
Tamoxifen and raloxifene have some long-term side effects (see table below) and may not be right for all women at higher risk. For example, tamoxifen increases the risk of cataracts and cancer of the uterus .
Talk with your health care provider about the potential harms and benefits of these drugs.
Learn more about the side effects of tamoxifen.
Learn more about talking with your health care provider.
Other side effects are less common.
These effects occur mainly in older postmenopausal women.
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*Please note, the information provided within Komen Perspectives articles is only current as of the date of posting. Therefore, some information may be out of date at this time.
Certain types of anti-depressants called selective serotonin reuptake inhibitors (SSRIs) can interfere with the metabolism of tamoxifen (how tamoxifen works in the body) [145,273].
If you are taking SSRIs to treat depression or menopausal symptoms (such as hot flashes), talk with your health care provider about possible drug interactions and other treatment options.
Researchers are studying tamoxifen use in women who have a BRCA1 or BRCA2 gene mutation.
Some findings suggest that tamoxifen may be more effective in preventing breast cancer in BRCA2 carriers than in BRCA1 carriers [152,274]. Tamoxifen only reduces the risk of estrogen receptor-positive cancers. BRCA2-related tumors are more likely than BRCA1-related tumors to be estrogen receptor-positive [152,275].
Tamoxifen may offer benefit to BRCA1/2 carriers who have been diagnosed with breast cancer in the past [148,267-277]. One study found the risk of breast cancer in the unaffected (opposite) breast may be reduced by 62 to 67 percent with tamoxifen use .
Most of what we know about the potential benefits and harms of tamoxifen come from data on white women. At this time, there are few data for women of other ethnicities.
However, studies show African-American women are more likely than white women to suffer from some of the harmful health effects of tamoxifen [278-279].
Aromatase inhibitors are hormone drugs that are part of standard treatment for estrogen receptor-positive breast cancer in postmenopausal women (learn more). Anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin) are aromatase inhibitors.
These drugs are now being studied to see whether they may lower breast cancer risk in postmenopausal women at high risk.
Findings from randomized controlled trials of cancer-free postmenopausal women at high risk have shown that the aromatase inhibitors exemestane and anastrozole may lower the risk of breast cancer by about half [179,280].
Unlike tamoxifen and raloxifene, exemestane and anastrozole do not appear to increase the risk of blood clots [179,280]. However, they can cause menopausal symptoms, a loss of bone density and other side effects (learn more) [281-284].
The American Society for Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) now list exemestane and anastrozole as risk-lowering drug options for postmenopausal women at higher risk of breast cancer. However, these drugs do not yet have FDA-approval for use in the risk reduction setting. These drugs are only FDA-approved for use in breast cancer treatment.
Learn about aromatase inhibitors (including exemestane and anastrozole) and breast cancer treatment.
Learn about the side effects of aromatase inhibitors.
The aromatase inhibitor drug letrozole is also being studied to see whether it may lower risk in postmenopausal women at high risk of breast cancer.
Learn about aromatase inhibitors and breast cancer treatment.
Other drugs currently used to treat breast cancer are under study for use in risk reduction and new risk-lowering drugs are being developed.
If you are at higher risk of breast cancer and are considering joining a clinical trial of risk-lowering drugs, discuss the potential risks and benefits of these drugs with your health care provider.
Learn more about emerging areas in breast cancer risk reduction.
Learn more about clinical trials.
Tamoxifen and raloxifene are available in generic forms. Generic drugs cost less than the name brands, but are just as effective.
Medicare and many insurance providers offer prescription drug plans. One may already be included in your policy or you may be able to buy an extra plan for prescriptions.
You may also qualify for assistance from programs that help with drug costs or offer low-cost or free prescriptions.
The Affordable Care Act requires insurance plans (started on or after September 24, 2014) to cover the cost (with no co-payments) of tamoxifen and raloxifene for women at high risk of breast cancer. Learn more about this coverage and the Affordable Care Act.
Read Komen’s statement applauding the government’s decision to cover these risk-lowering drugs.
Learn more about insurance plans and prescription drug assistance programs.
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