The cost of treatment is provided in a side bar: raloxifene is about $75 for a month’s supply, while tamoxifen is about $100. Story notes that medication is taken daily for 5 years. Provides relative risk reduction of chemoprevention with hormone therapy for high-risk women, however, no absolute risk reduction provided. No quantitative risks mentioned for taking hormone therapy for chemoprevention. Incomplete discussion of reduced rate of side effects in raloxifene group. Mentions harms of hormone therapy, such as an increased risk of blood clots and uterine cancers. Notes that there were “fewer side effects” (i.e. blood clots and uterine cancers) in the raloxifene group, but does not mention that the difference in side effects was not statistically significant for uterine cancer and blood clots. This information was not readily available on the National Cancer Institute (NCI) website or in reports of the study, the story presents caveats on the drugs. Mentions reduction in the risk of cataracts with raloxifene, which was statistically significant. Does mention that raloxifene, like tamoxifen, has bothersome side effects such as hot flashes and vaginal discharge, which are reported as comparable and mild to moderate in the NCI press release of the initial results of this trial. The story discusses study design and notes that results have not yet been peer-reviewed in a medical journal. Story also notes that tamoxifen protects women from DCIS (ductal carcinoma in situ) and LCIS (lobular carcinoma in situ) better than raloxifene. However, no quantitative evidence is presented on benefits or side effects of either drug, and no mention that the study was unblinded early. Chemoprevention is for a small number of women and tamoxifen should only be offered to women with a 5-year projected risk for breast cancer of 1.6% in order to reduce their risk. The side bar is helpful, providing a clearer understanding of who might be at higher risk. Also, this medication is for women with estrogen-receptor positive breast cancer. This article does a good job of explaining that this drug is only for postmenopausal women with a greater chance of malignancy and the benefit of the drug must be weighed against the health risks for each woman. This study was partially funded by Eli Lilly and AstraZenaca, makers of Evista and tamoxifen, though this is not mentioned. There is also no mention of whether the breast cancer expert cited from the American Cancer Society has financial ties with these drug companies. The story does mention another chemoprevention hormone drug, tamoxifen. It also mentioned aromatase inhibitors as options being investigated for chemoprevention. Does not mention need for mammograms (screening as early detection shown to improve outcomes) in post-menopausal women at a higher risk of breast cancer. It should be noted that the results presented in this story are initial findings after 4 years of raloxifene. Tamoxifen is usually taken for 5 years and there is much more long-term clinical data on safety and efficacy for this drug. The study was unblinded early due to the improved side effect profile for raloxifene, which was not statistically significant. The story mentions that raloxifene is currently available for use in post-menopausal women to prevent osteoporosis and that use in chemoprevention has only been in clinical trials–more data is needed prior to FDA approval for use as chemoprevention. Use as chemoprevention would be off-label and only women with an increased risk of breast cancer. Notes that use of raloxifene (Evista) as chemoprevention is new. Evista is already approved to prevent osteoporosis. Does not appear to be directly from a press release and there is a link for more information on study at NCI website. Breast cancer experts not affiliated with the NCI trial provide perspective in interpreting the results.
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