SynthesisJournal of clinical oncology : official journal of the American Society of Clinical Oncology2023
Reassessing the Benefits and Harms of Risk-Reducing Medication Considering the Persistent Risk of Breast Cancer Mortality in Estrogen Receptor-Positive Breast Cancer.
Synthesis in Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.
- Society of Surgical Oncology Breast Disease Site Working Group Statement on Bilateral Risk-Reducing Mastectomy: Indications, Outcomes, and Risks.Annals of surgical oncology · 2025Pooled it
- Healthcare provider perspectives on a clinical decision tool to support individualized exercise prescriptions and discussions for breast cancer survivors.Journal of cancer survivorship : research and practice · 2026Article
- Breast cancer survivors' perspectives on a clinical decision tool to support individualized exercise prescriptions and discussions.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026Article
- Pharmacotherapeutic considerations of selective estrogen receptor modulators for vascular protection.Frontiers in pharmacology · 2026Review
- Tumor microenvironment-responsive cerium oxide nanozyme coated ZIF-8 nanoplatform with ICG encapsulation for precise breast cancer surgery and efficacious synergistic suppression.Materials today. Bio · 2025Article
- Impact of Complex Genetic and Drug-Drug Interactions on Tamoxifen Metabolism and Efficacy.Journal of personalized medicine · 2025Review
- Development and Validation of a Simulation Model-Based Tool to Support Individualized Physical Activity Discussions and Prescriptions for Breast Cancer Survivors.JCO clinical cancer informatics · 2025Article
- Highly efficient NIR-II photothermal therapy amplified ROS oxide breast tumor therapy by mesoporous gallium-enriched platinum nanomedicine.Materials today. Bio · 2025Article
- Review
- Divergent ERα co-factor landscapes in gynecological cancers: implications for disease progression and therapy.Biochemistry and cell biology = Biochimie et biologie cellulaire · 2025Review
- Benefits and Harms of Mammography Screening in 75 + Women to Inform Shared Decision-making: a Simulation Modeling Study.Journal of general internal medicine · 2024Article
- Opportunities, challenges, and future directions for simulation modeling the effects of structural racism on cancer mortality in the United States: a scoping review.Journal of the National Cancer Institute. Monographs · 2023Article
Corrections and comments
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Authors and funding
12 authors at 8 institutions in 1 country.
Funding
Abstract
purposeRecent studies, including a meta-analysis of 88 trials, have shown higher than expected rates of recurrence and death in hormone receptor-positive breast cancer. These new findings suggest a need to re-evaluate the use of risk-reducing medication to avoid invasive breast cancer and breast cancer death in high-risk women.
methodsWe adapted an established Cancer Intervention and Surveillance Modeling Network model to evaluate the lifetime benefits and harms of risk-reducing medication in women with a ≥ 3% 5-year risk of developing breast cancer according to the Breast Cancer Surveillance Consortium risk calculator. Model input parameters were derived from meta-analyses, clinical trials, and large observational data. We evaluated the effects of 5 years of risk-reducing medication (tamoxifen/aromatase inhibitors) with annual screening mammography ± magnetic resonance imaging (MRI) compared with no screening, MRI, or risk-reducing medication. The modeled outcomes included invasive breast cancer, breast cancer death, side effects, false positives, and overdiagnosis. We conducted subgroup analyses for individual risk factors such as age, family history, and prior biopsy.
resultsRisk-reducing tamoxifen with annual screening (± MRI) decreased the risk of invasive breast cancer by 40% and breast cancer death by 57%, compared with no tamoxifen or screening. This is equivalent to an absolute reduction of 95 invasive breast cancers, and 42 breast cancer deaths per 1,000 high-risk women. However, these drugs are associated with side effects. For example, tamoxifen could increase the number of endometrial cancers up to 11 per 1,000 high-risk women. Benefits and harms varied by individual characteristics.
conclusionThe addition of risk-reducing medication to screening could further decrease the risk of breast cancer death. Clinical guidelines for high-risk women should consider integrating shared decision making for risk-reducing medication and screening on the basis of individual risk factors.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.