Breast Cancer Current Topics in Breast Cancer

Breast Cancer Prevention Drug Not Worth the Cost?

Many women who are at a high risk of developing breast cancer take the preventative drug tamoxifen. But new research shows that this drug, which was approved by the Food and Drug Administration in 1998 for such purposes, may not be so cost effective.

Currently, FDA guidelines state that tamoxifen should be given to women who have a 1.67 percent or greater chance of developing breast cancer. This risk is based on a family history of the disease and other factors. However, with the high cost and only moderate chance that this it will prevent cancer, new research is showing that this risk threshold may need to be raised before doctors suggest that their patients begin to take this potent drug.

"We found that for women at the lower end of the high-risk range for developing breast cancer, there is a very small likelihood that taking tamoxifen will reduce mortality," said study author Joy Melnikow, professor of family and community medicine at UC Davis School of Medicine and Medical Center in a press release.

Prior to FDA approval, studies had showed that tamoxifen use resulted in a 49 percent reduction in certain inherited breast cancers among women at high risk for the disease.

That sounds great, but tamoxifen costs, on average, about $1,212 a year in the United States. And the drug, which is also used to not only prevent, but treat certain types of breast cancer, has also been found to cause cataracts, deep vein thromboses, endometrial cancer and stroke.

Using a formula that included the cost of the drug and the number of women saved from breast cancer because of this drug, Melinikow calculated that for every year of life saved, tamoxifen costs well over $1.3 million. In comparison, an annual flu shot, colonoscopy and mammography costs about $980, $11,000 and $58,000, respectively, per year of life saved. The results of the study will be published in the journal Cancer.

If the threshold of breast cancer risk is raised to include only those at highest risk—over 3 percent—tamoxifen's effectiveness increases significantly enough to make the cost of the drug worth it, the authors say, especially for those women who have had a hysterectomy and do not need to worry about developing endometrial cancer while on the drug.

"This would support revising the current recommended risk threshold for physicians to counsel women about tamoxifen," said Melinikow.