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Drugs Approved for Breast Cancer

23 February, 2021

This blog on Breast cancer chemoprevention clarifies doubt about why Medicines are chosen as a reliable and medically approved treatment option in order to reduce breast cancer risk and prevention. Also highlights three approved drugs for the same along with benefits and risk involved.

According to the Cancer Statistics, 2020 Report that was researched and created by the National Cancer Registry Programme in India, 1 in 29 females will develop breast cancer during their lifespan. Breast cancer, along with cervix, uterus, and ovary cancer, constitutes for 53% of all cancers that are likely to occur in women in the country.

Like every other form of cancer, breast cancer also begins when the healthy cells in a body start to change uncontrollably, leading to the formation of a mass or tumour. It generally takes years for a healthy cell to turn cancerous.

Chemoprevention is a method where a natural or laboratory made substance is used to prevent cancer from developing. Medicines such as Tamoxifen, Raloxifene, or Aromatose can help reduce the risk of breast cancer in women.

Here, we attempt to answer some of the most common doubts that women may have regarding Chemoprevention medication and its usage.

ARE CHEMOPREVENTION MEDICINES A VIABLE OPTION FOR ME?

Before considering Chemoprevention, it is crucial to consult a specialist who is aware of your medical history and can assess whether you need these medicines.

Breast cancers are estrogen receptor positive (ER-positive) which means that the cancer depends on the hormone estrogen to grow. Chemoprevention medicines such as Tamoxifen dissuade the support that estrogen in the body provides the cancer to grow. Researchers have found that Tamoxifen also helps prevent the recurrence of cancer in women.

Your health care provider might consider you as a candidate for Chemoprevention depending on:

1. Your age
2. Your family history of breast cancer
3. Detection of an abnormality in your breast biopsy
4. Age at which your first pregnancy occurred or if you are planning a pregnancy
5. Your menstrual history
6. Whether you are breastfeeding
7. Your history of developing blood clots

A study of the aforementioned factors by your health care provider can help in assessing the chances of you developing breast cancer. Basis this and your general health conditions, your doctor might consider Chemoprevention as a viable option for you.

HOW WILL BREAST CANCER RISK BE ASSESSED?

In 1989, Dr Mitchell Gail and his colleagues at the Biostatistics Branch of the National Cancer Institute in America, screened 2,80,000 women between the age of 35-74 years, and devised a risk assessment algorithm called the Gail Model. It is one of the most widely used risk assessment tools to estimate the development of breast cancer and subsequently help prevent it. While white women have shown a considerable success when using the Gail Model, researchers have supplemented it to provide accurate risk assessment for Asian women as well.

The Gail Model requires details of age, menstrual history, pregnancy, history of cancer in the family, race/ethnicity, and breast biopsy. If the result is a score of more than 1.7%, then the risk of developing breast cancer is high.

The Gail Model, although widely used, does have it limitations, and doctors often use it as an initial method of detection. Women with a score of >1.7% are required to undergo a series of tests and health assessments before they are deemed fit to consume Chemoprevention medicines.

WHAT ARE SOME OF THE APPROVED CHEMOPREVENTIVE MEDICINES?

There is much research that is still required when it comes to Chemopreventive medicines. Different results are found in different women who use them. Three of most commonly used drugs for Chemoprevention are - Tamoxifen, Raloxifene and Aromatose.

Tamoxifen works by blocking the effects of estrogen on the cancer cells to prevent their growth. High risk women, above the age of 35 are prescribed this medicine which comes in a pill form and is usually taken once a day for a period of 5 years or more. Some of the side effects of Tamoxifen are the formation of blood clots, cataract, and in rare cases the development of uterine cancer. Cytotam, Caditam and Oncotam are some of the brand names under which Tamoxifen is sold in India.

Raloxifene works in a similar way as Tamoxifen by inhibiting estrogen from helping the cancer cells to grow. Apart from helping in prevention of breast cancer, Raloxifene has also shown to prevent the development of bone thinning osteoporosis in postmenopausal women. Women with heart disease are at a risk of increased number of strokes with this drug. Other side effects include weight gain, hot flashes, and vaginal irritation. Ralista and Fiona are the brand names under which this drug is sold in India.

Aromatose inhibitors have been proven to be more effective for postmenopausal women and those who have a history of cancer in their family. Aromatose inhibitors are a recent addition to the list of Chemoprevention medicines for breast cancer. Further research is ongoing to understand these inhibitors better and to use them in a wider range of women. Aromasin, a medicine that contains an Aromatose inhibitor called Exemestane, is one of the options available in India.

WHAT ARE THE RISKS AND BENEFITS OF CHEMOPREVENTION MEDICINES?

Like any other medicine, Chemoprevention drugs come with their own set of side effects. Regardless of whether you are at risk for breast cancer, Chemoprevention may not be a suitable option for you. However, if your doctor and you have made an informed decision and the benefits outweigh the risks, then Chemoprevention can be a life altering option for you.

Some of the risks and benefits of Chemoprevention are mentioned below:

BENEFITS:

1. Prevent the development of breast cancer in women above the age of 35 or who are postmenopausal.
2. Prevent the recurrence of cancer in women who have already undergone treatment for it.
3. Raloxifene is also helpful to reduce the occurrence of osteoporosis in postmenopausal women.

RISKS:

1. Increased risk of blood clots when using Tamoxifen and Raloxifene.
2. Women with heart disease are at an increased risk of experiencing a stroke.
3. There is a risk of uterine cancer development in women who have undergone menopause.
4. Hot flashes, sweating at night, vaginal dryness and discharge, headache and fatigue are common side effects of Chemoprevention medicines.

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