BCA Updates Its ”Pills for Prevention” Policy

by Jane Zones

Since the organization’s founding in 1990, Breast Cancer Action has emphasized the need to find the root causes of breast cancer in order to truly prevent the disease. Abundant evidence indicates that the genesis of many cases of breast cancer lies within our toxic environment. Yet, by far, the focus of national resources devoted to breast cancer prevention has been on the development of drugs to lower the incidence (new cases) of breast cancer, rather than on finding the environmental triggers of the disease.

In 1996 BCA adopted its first “Pills for Prevention” policy, which concentrated on tamoxifen—approved in 1998 for use by healthy women to lower breast cancer risk. BCA’s perspective was that tamoxifen’s side effects were so serious and common that its benefits did not override safety concerns. Since that time, other drugs have been introduced and are being tested for their ability to lower breast cancer risk in healthy women. For this reason, BCA decided earlier this year to update its policy statement.

Raloxifene (trade name Evista), which has similar benefits and risks as tamoxifen, and is in the same category of drugs, is now being promoted as a breast cancer “preventative,” though it has not yet been approved for that use by the U.S. Food and Drug Administration (see “Pushing Raloxifene—Reports of the STAR Trial” in BCA Newsletter #92).

Aromatase inhibitors (AIs) are the other class of drugs being touted to lower breast cancer risk. Each of the AIs has been used successfully as treatment for women with breast cancer, and their manufacturers are eager to expand their market. A number of issues have led BCA to urge women to think carefully before accepting pills as a means to reduce their chances of developing breast cancer:

  • Lack of long-term follow-up research on safety
  • The current practice of comparing the drugs with each other, rather than with a placebo control
  • Misleading reporting of findings that exaggerate benefits and understate risks.

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These issues are addressed in detail in BCA’s policy statement, as are characteristics of the major treatments being studied for risk reduction. A concerted campaign is now underway in the medical community to boost the number of people taking drugs to lower their risk for cancer. The American Association for Cancer Research’s (AACR) Chemoprevention Working Group advocates “widespread implementation of chemoprevention of cancer.”1 It proposes a broad educational promotion directed at physicians and “society as a whole” to accomplish this. The centerpiece of the AACR campaign is to correct the “misperception” that healthy people should not be treated with possibly harmful drugs.

Breast Cancer Action, while clearly understanding the large numbers of women at risk for developing breast cancer, does not advocate using drugs to treat risk. Women deserve to be fully informed about the benefits and risks of breast cancer “prevention” drugs prior to making a decision about whether or not to take them. It is difficult to imagine a drug powerful enough to actually reduce the risk of breast cancer that will not have serious side effects. Moreover, the focus on pills for prevention of disease diverts resources from finding and eradicating environmental causes of, as well as more effective treatments for, breast cancer.

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1 “Prevention of Cancer in the Next Millennium: Report of the Chemoprevention Working Group to the American Association for Cancer Research,” Cancer Research 59, October 1, 1999, pp. 4743-4758.

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