Chemoprevention of breast cancer: A joint guideline from the Canadian Task Force on Preventive Health Care and the Canadian Breast Cancer Initiative's Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer

摘要: Objective: To assist women and their physicians in making decisions regarding the prevention of breast cancer with tamoxifen raloxifene. Evidence: Systematic review English-language literature published from 1966 to August 2000 retrieved MEDLINE, HealthSTAR, Current Contents Cochrane Library. Values: The strength evidence was evaluated using methods Canadian Task Force on Preventive Health Care Steering Committee Clinical Practice Guidelines for Treatment Breast Cancer. Recommendations: · Women at low or normal risk (Gail assessment index There is fair recommend against use reduce disease (grade D recommendation).· higher ≥ 1.66% 5 years): Evidence supports counselling high potential benefits harms B recommendation). cutoff defining arbitrary, but National Surgical Adjuvant Bowel Project P-1 Study included a 5-year projected least according Gail index, average patients entered trial 3.2%. Examples high-risk clinical situations are 2 first-degree relatives cancer, history lobular carcinoma situ atypical hyperplasia. As increases above 5% outweigh harms, woman may choose take tamoxifen. duration such years based results trials involving early cancer. If raises concerns has already been calculated be risk, then individuals experienced skilled discuss use. Important additional issues: Prevention raloxifene: does not support recommending chemoprevention raloxifene outside setting.· Screening index: This main eligibility criterion enrolling one study that showed benefit chemoprevention. However, it as routine screening case-finding instrument; validation required. Overall, current shift its physicians9 offices case finding. when her physician concerned about woman9s increased can useful tool deciding whether pursue an in-depth discussion Hence, approach identifying who warrant shared decision-making will vary across practices. (The available online http://bcra.nci.nih.gov/brc/).[A patient version these guidelines appears Appendix 2.] Validation: authors9 original text revised by both final document reflects consensus contributors. Sponsor: Canada. Completion date: February 2001.