Use of endocrine therapy for breast cancer risk reduction: ASCO clinical practice guideline update

Kala Visvanathan, Carol J. Fabian, Elissa Bantug, Abenaa M. Brewster, Nancy E. Davidson, Andrea DeCensi, Justin D. Floyd, Judy E. Garber, Erin W. Hofstatter, Seema A. Khan, Maria C. Katapodi, Sandhya Pruthi, Rachal Raab, Carolyn D. Runowicz, Mark R. Somerfield

Research output: Contribution to journalReview articlepeer-review

31 Scopus citations


PURPOSE To update the ASCO guideline on pharmacologic interventions for breast cancer risk reduction and provide guidance on clinical issues that arise when deciding to use endocrine therapy for breast cancer risk reduction. METHODS An Expert Panel conducted targeted systematic literature reviews to identify new studies. RESULTS A randomized clinical trial that evaluated the use of anastrozole for reduction of estrogen receptor–positive breast cancers in postmenopausal women at increased risk of developing breast cancer provided the predominant basis for the update. UPDATED RECOMMENDATIONS In postmenopausal women at increased risk, the choice of endocrine therapy now includes anastrozole (1 mg/day) in addition to exemestane (25 mg/day), raloxifene (60 mg/day), or tamoxifen (20 mg/day). The decision regarding choice of endocrine therapy should take into consideration age, baseline comorbidities, and adverse effect profiles. Clinicians should not prescribe anastrozole, exemestane, or raloxifene for breast cancer risk reduction to premenopausal women. Tamoxifen 20 mg/day for 5 years is still considered standard of care for risk reduction in premenopausal women who are at least 35 years old and have completed childbearing. Data on low-dose tamoxifen as an alternative to the standard dose for both pre- and postmenopausal women with intraepithelial neoplasia are discussed in the Clinical Considerations section of this article. Additional information is available at

Original languageEnglish (US)
Pages (from-to)3152-3165
Number of pages14
JournalJournal of Clinical Oncology
Issue number33
StatePublished - 2019

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


Dive into the research topics of 'Use of endocrine therapy for breast cancer risk reduction: ASCO clinical practice guideline update'. Together they form a unique fingerprint.

Cite this