Tamoxifen May Cut Risk of Breast Cancer in Half

In April, the National Cancer Institute announced that raloxifene (evista) was as good as tamoxifen at preventing invasive breast cancer. Their conclusion was based on a study of 20,000 high-risk women in which half were given tamoxifen and half raloxifene for a five-year period.

Statistical results were roughly equal, although raloxifene was touted as having fewer unwanted side effects than tamoxifen. There were 163 cases of breast cancer in the group taking tamoxifen, compared to 167 in women taking raloxifene.  With either group, the cases of breast cancer that developed during the study were about half as many as if the women had not been treated.


Like those on tamoxifen, a very small number got uterine cancer or developed blood clots,  potential side effects of either drug. With those on raloxifene, these conditions developed at a slightly lower rate, but the numbers are small and therefore not very statistically significant. These conditions could have developed by chance and not have been related to taking the drug.

The principal difference found was that raloxifene lowered the risk of “invasive” breast cancer, but did not protect for lobular and ductal carcinomas in situ. These non-invasive cancers can develop into invasive cancers, which are the type that kill, but they can be effectively treated when found early. Tamoxifen appears to lower the risk for both invasive and non-invasive cancers.

Taking either drug is risk reduction, not prevention. You are treating a large number of healthy women, who might develop unwanted side effects, while helping only a small number to avoid breast cancer. In 1,000 high-risk women, approximately 20 women treated would avoid getting breast cancer, while another 20 would develop it despite taking the medications.  This means that 980 women are exposed to the drugs’ risks but will get no cancer benefit.

Since there is no way to predict who will get breast cancer, high-risk women must choose whether they wish to take the medications that can have unpleasant side effects such as hot flashes and other menopausal symptoms.

At some point in the future, we may be able to pinpoint who is actually at high risk of breast cancer. Then, taking these medications will make more sense for women who are otherwise healthy.

Another development on the horizon is a study to test a class of drugs called aromatase inhibitors, which are used to treat breast cancer. They may do a better job of prevention than either tamoxifen or raloxifene.

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