A cheap daily tablet should be offered to women as young as 18 to slash their risk of breast cancer in half, according to a leading expert, sparking controversy among doctors.
Dr Rebekah Law, a breast cancer surgeon at the prestigious Royal Marsden hospital, believes the 45p pill, tamoxifen, should be offered ‘in the same way as statins’ – the safe and highly effective daily tablets taken by millions to cut their risk of deadly heart disease.
Currently, tamoxifen is mainly used on the NHS to treat women who already have breast cancer – or to prevent the disease from returning.
In some cases, it is offered to women with a strong family history of the disease or cancer-causing genetic mutations, to prevent the disease from occurring.
However, speaking exclusively to the Daily Mail at the European Breast Cancer Conference in Barcelona, Dr Law argued that women with an increased risk of the disease – such as those with a close family history of breast cancer, for example in a mother or sister – should be offered the chance to take tamoxifen.
Significantly, Dr Law argues that any women – regardless of family history or genetics – who is concerned about developing breast cancer should be allowed to request a tamoxifen prescription.
Unlike statins, which have to be taken for life, Dr Law argues that patients only need to be on tamoxifen for five years in order to lower their risk of breast cancer for the following 20 years.
She says the major intervention is needed to combat the rising number of young women developing breast cancer. More than 10,000 under-50s are diagnosed with the disease every year in the UK now – 10 per cent more than in 2010.
Experts from both sides of the debate are concerned that we are leaving screening too late
Dr Law also argues that it is better to prevent breast cancer from occurring than to treat it. Studies show that women who get the disease are significantly more likely to see it return later in life. They are also more likely to suffer financially as a result of their illness and to develop long-term complications such as chronic pain.
But many other experts oppose the move, arguing that tamoxifen can have serious side-effects including debilitating symptoms – often likened to an early menopause – as well as significantly raising the risk of birth defects.
However, despite these criticisms, Dr Law is adamant that women must be given the chance to take tamoxifen.
‘Tamoxifen should be offered in the same way as statins to all women at risk of breast cancer ,’ she says.
‘If you give women who are at an increased risk of developing breast cancer a drug like tamoxifen, then you can significantly reduce their risk of developing the disease by up to 50 per cent.
‘So I believe at the very least we should encourage women to give it a go.’
So, what is tamoxifen? And is it right for you?
It has long been recommended that women at moderate to high risk of breast cancer should be offered preventive treatments such as tamoxifen
‘We are seeing more affected women than healthy women so we need to think about a new system to increase prevention uptake,’ says Dr Pascal Pujol, head of oncogenetics at the University Hospital of Montpellier
The need for better ways to prevent breast cancer is clear. The disease affects around 58,000 women every year. While in recent years revolutionary new drug treatments have increased the number of patients who beat breast cancer, it still kills more than 11,000 every year in the UK.
Tamoxifen is what is known as an oestrogen receptor modulator. This means it blocks the female sex hormone oestrogen from getting into breast tissue. This is crucial because many types of breast cancer feed off oestrogen.
Studies show that, via this mechanism, drugs like tamoxifen can stop breast cancer from spreading and – in combination with other treatments like chemo and surgery – can cure patients.
Crucially, research also shows that tamoxifen can slash the risk of breast cancer developing by as much as 50 per cent.
However, only a small number of women – those considered to be at high-risk of developing breast cancer – are offered tamoxifen for this purpose on the NHS.
This is because tamoxifen has a number of side-effects, including hot flushes and night sweats, mood changes and fatigue. It can also lead to irregular periods or stop them altogether.
For this reason, experts liken the side-effects of tamoxifen to an early menopause – though most women find that their periods return if they stop taking the tablets.
Experts warn that tamoxifen also raises the risk of life-threatening complications. Studies show that tamoxifen patients are nearly three times more likely to develop deadly blood clots and endometrial cancer.
Moreover, tamoxifen patients are warned not to get pregnant while on the drug as it significantly raises the risk of birth defects, including physical deformities and genetic diseases.
However, Dr Law argues that these tamoxifen complications only occur when the tablet is taken at high doses.
Instead, she is calling for patients to be offered a smaller daily dose – a quarter of the current amount – in order to avoid these side-effects.
She argues that, on this low tamoxifen dose, patients typically only suffer one hot flush a day, while also seeing their risk of cancer drastically cut.
Dr Law concedes that, since, historically, tamoxifen studies have only involved patients over the age of 30, there is currently no data on how effective it is at preventing cancer in younger people.
However, she believes it will have the same protective effect in women as young as 18.
But, other experts say even the smaller dose could put women at needless risk of side-effects and complications.
‘We don’t want to impact an otherwise healthy woman’s quality of life and sexual wellness just because there is a slight risk she might develop the disease further down the line,’ says Dr Pascal Pujol, a cancer expert at the University Hospital of Montpellier in France.
Experts also point out that, today, a breast cancer diagnosis is not a death sentence. In fact, research shows that nine in ten women are alive five years after diagnosis. Eight out of ten are alive a decade later.
Others argue that lifestyle changes – like losing excess weight, exercising regularly, and limiting smoking – are effective at lowering the risk of breast cancer, without any of the potential complications of medicines like tamoxifen.
But Dr Law argues that there are many other reasons why women would want to avoid getting the cancer in the first place.
Studies show women who develop breast cancer are significantly more likely to see it return later in life – at which point it is often harder to treat.
Complications during breast cancer treatment are also common. Studies show that half of women who have breast surgery will experience persistent pain after the procedure.
Meanwhile, a major study, soon to be published, found that a breast cancer diagnosis can cost women up to £12,000 a year, in large part due to lost wages, childcare and travel costs.
Dr Law also says that many women who could benefit from tamoxifen – those who are considered at high-risk – are unaware of the tablet.
Surveys have shown that only 2 per cent of women who receive regular breast cancer screening – meaning they are scanned for the disease every few years – have heard of tamoxifen.
‘We shouldn’t be force-feeding women preventative medication, but we need to be raising awareness and normalising the use of endocrine drugs like tamoxifen,’ she says.
‘We have all heard of statins. Our grandparents take them, our parents take them so there is a collective understanding that this is normal – so when we come to be offered it, we are more likely to say yes.
‘There are huge similarities between the two drugs [statins and tamoxifen] and yet because we haven’t normalised it in society, women aren’t aware of its potentially life-saving effects.’
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