Tamoxifen+Conclusion

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Conclusion
Our suggestions are based on evaluation of the studies and other information we have found about tamoxifen and other chemoprevention options. However, this is not physician approved. Even the BCPT suggests that women weigh the benefits with the risks of taking tamoxifen or another chemoprevention method as well as speaking with their physician to aid in making their decision. "The decision to take tamoxifen is an individual one. A woman and her doctor must carefully consider the benefits and risks of [|therapy]. At this time, there is no evidence that tamoxifen has a net benefit for women who do not have an increased risk of developing breast cancer."



Our suggestion for Kate would be to wait until menopause to consider taking Tamoxifen. While tamoxifen does not start menopause early, it does produce menopause-like symptoms, which to her, feels unnatural and very much like starting menopause. Since she has fibrocystic disease, however, she gets mammograms more frequently. This would allow any breast cancer to be detected early enough to ensure successful treatment. She does have a strong family history and other increased risk factors, making her an ideal candidate for chemoprevention. However, because the risks of taking tamoxifen are lessened as a postmenopausal woman, it would be to Kate's benefit to wait.
 * Case Study 1:**

Alexandra's concern about raloxifene being as effective as tamoxifen is easily reassured. From our research, we found that raloxifene is as effective as tamoxifen in preventing both invasive and noninvasive breast cancers. Unfortunately, the lessened side effects, such as uterine cancer, were not statistically significant even though they were touted as such. On the other hand, the risk of thromboembolic effects were lessened with raloxifene in comparison to tamoxifen. This was statistically significant. However, raloxifene has not been studied in premenopausal women, so it is not an option for Alexandra. Because of her [|BRCA] mutations, her risk for breast cancer as well as other cancers is greatly increased. Knowing that she has this mutation most likely causes her emotional distress. A chemopreventive drug could decrease her emotional burden. However, some harmful BRCA mutations increase risk for uterine cancers as well. Because uterine cancer is a major side effect of tamoxifen, she should speak to a genetic counselor to discuss her BRCA mutation to ensure she does not have an increased risk for uterine cancers before taking tamoxifen. If she does not have a mutation in the BRCA genes that increases her risk for uterine cancer, tamoxifen would be a good option for her. Given the she is an African-American woman, she is less likely to have a mutant CYP protein required to metabolize tamoxifen to endoxifen, allowing for tamoxifen's drug action.
 * Case Study 2:**

Rebecca is a prime candidate for SERMs as chemoprevention. She has an increased risk for breast cancer and is postmenopausal. Not only is tamoxifen, and raloxifene, safe for postmenopausal women to take and effective, because it can act as an estrogen analogue in tissues other than the breast, the drugs could be used in conjunction with hormone replacement therapy. Tamoxifen also decreased hip and other fractures as well as ischemic heart disease, both common symptoms in postmenopausal women. For Rebecca, the benefits of tamoxifen would greatly outweigh any of the risks.
 * Case Study 3:**