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Decision Aid Tool: Medications to Reduce the Risk of Developing Breast Cancer This tool is to help women who have an increased risk of developing breast cancer to decide whether or not medication to help reduce the risk of developing breast cancer is right for them. The medications discussed are Tamoxifen, Raloxifene, and Exemestane. This aid is not intended to be a comprehensive guide, but rather a starting point for a discussion with your doctor. Talk to your doctor about increased risks for developing breast cancer and the treatments that are available. Tamoxifen Who can take this medication? ≥ 35 years of age Pre- or postmenopausal a 5-year projected risk ≥ 1.66% b or with LCIS What are the possible benefits? Raloxifene ≥ 35 years of age Postmenopausal women a 5-year projected risk ≥ 1.66% or with LCIS Exemestane* ≥ 35 years of age Postmenopausal a 5-year projected BC risk ≥1.66% All three drugs may reduce the risk of invasive breast cancer, especially in women who develop estrogen receptor positive breast cancer (that is breast cancer that can be treated with hormonal therapy). It may be also be protective for up to 10 years, even when taken for only 5 years It may also treat or prevent osteoporosis It may also treat early or advanced estrogen receptor positive breast cancer What are possible rare side effects that women may experience? What are more common side effects that women may experience? Thromboembolic events Cardiovascular events Endometrial cancer Thromboembolic events Cardiovascular events A decrease in bone mineral density Hot flashes, leg cramps, peripheral edema, flu syndrome, arthralgia, and sweating Hot flashes, sweats, arthralgia, headache, and insomnia Who should not take this medication? Hot flashes, sweats, vaginal discharge, dryness, and menstrual irregularities Bone loss for premenopausal women Women with a prior history of blood clots in the veins or in the lung, or with stroke or stroke-like events Women who are, or may become, pregnant, or nursing mothers Women who are premenopausal Women with a prior history of blood clots in the veins or in the lung, or with stroke or stroke-like events Women who are premenopausal You may experience some of You may experience some of You may experience some of the side effects listed above, the side effects listed above, the side effects listed above, although the majority tend to although the majority tend to although the majority tend to go away after treatment is go away after treatment is go away after treatment is complete. complete. complete. Women report fewer breast complaints and headaches, especially during treatment. There are some reports of a slight increase in problems related to sexual functioning. a According to the National Cancer Institute Breast Cancer Risk Assessment Tool. b Recommendations are based on the 2013 ASCO Breast Cancer Risk Reduction Guideline Update, www.asco.org/guidelines/bcrr *Exemestane is not approved by FDA for breast cancer prevention How could it affect quality of life? Additional questions: What is the comparative effectiveness of these three drugs? What other resources are available to me in making my decision? The Expert Panel for this Guideline Update wishes to express its gratitude to Rose Z. Morrison for her assistance in the development of this tool.