Can we afford chemoprevention? A critical practical issue is whether we have sufficient resources to support a nationwide breast cancer chemoprevention program. Experts estimate that as many as 9 million menopausal women in the United States are at increased risk for breast cancer. Who will identify these women and counsel them concerning the chemoprevention option? Who will prescribe and supervise chemo-prevention for these women?
Likely gynecologists, along with internists, family physicians, and oncologists will play a central role. ObGyns are experts in managing breast cancer screening using mammography. We also have experience prescribing raloxifene for osteoporosis. It would not stretch our current screening mammography practices to add the recommendation that patients perform a risk assessment using the Gail model,1 and consider chemoprevention if they are at increased risk.
CASE Consider raloxifene when uterus is intact
In the case of a 55-year-old woman with a 5-year breast cancer risk of 4%, a consideration of the risks and benefits may well lead to a recommendation to initiate chemoprevention with raloxifene. For this woman, with an intact uterus, raloxifene is likely the superior choice because of the increased risk of endometrial cancer associated with tamoxifen use.
The STAR trial is coordinated by the National Surgical Adjuvant Breast and Bowel Project (NSABP), a network of cancer research professionals, and is sponsored by the National Cancer Institute (NCI), part of the National Institutes of Health.
- Tools to calculate breast cancer risk
- STAR trial fact sheet NCI’s STAR home page at
NSABP’s Web sites at
- Q&A on STAR results