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For women with a higher-than-average risk of breast cancer, some medicines can help reduce this risk. But these drugs can also have side effects. It’s important to understand the benefits and risks before deciding to take one.

Am I at higher risk for breast cancer?

A risk factor is anything that raises your risk of getting a disease. Your healthcare team can determine if you are at higher-than-average risk for breast cancer. But keep in mind, having risk factors doesn’t mean that you will develop breast cancer. In fact, most people who have one or more risk factors never develop breast cancer.

Some important risk factors for breast cancer include:

• Getting older
• Having close relatives, such as a parent, sibling, or child, who have had breast cancer
• Having more menstrual cycles over your lifetime
• Having invasive breast cancer or ductal carcinoma in situ (DCIS) before
• Being diagnosed with lobular carcinoma in situ (LCIS)
• Being diagnosed with atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH)
• Having a gene mutation linked to a family cancer syndrome (such as a BRCA mutation)

Some of these factors can increase your risk more than others.

How is breast cancer risk assessed?

Researchers have built some models to help predict a woman’s risk of getting breast cancer. For example, the is commonly used to assess risk. It can estimate your risk of getting breast cancer in the next 5 years and over your lifetime based on many of the factors listed above.

Other risk assessment tools might be used by genetic counselors and other healthcare professionals, such as the Tyrer-Cuzick, BCSC, and BOADICEA.

These tools can give you a rough estimate of your risk. But no tool or test can tell for sure if you’ll develop breast cancer.

Newer tools can use imaging test results, such as mammograms, and artificial intelligence (AI) to identify women at higher risk of developing breast cancer. Some of these tools are still being tested.

When is breast cancer risk high enough to consider medicine?

There is no single definition of a higher-than-average risk of breast cancer.

Using the Breast Cancer Risk Assessment Tool, some experts use a 1.7% risk of developing breast cancer over the next 5 years as their cut-off point. This is the average risk for a 60-year-old woman. Using the Tyrer-Cuzick model, a 5% or more chance of developing breast cancer over the next 10 years is used as a cut-off point. Talk with your doctor about what model they use to estimate risk and what this means for you.

Some medical organizations recommend that doctors discuss the use of medicines to lower breast cancer risk in women at least 35 years old who meet one of these cut-off points. Any woman who has a personal history of LCIS or atypical hyperplasia may also be offered medicine to prevent breast cancer (chemoprevention).

The American Cancer Society does not have recommendations for using medicines to help lower the risk of breast cancer.

What are risk-reducing medicines?

Certain medicines can lower the risk of getting a disease. In breast cancer you might also hear this called chemoprevention or endocrine therapy.

The most commonly used medicines to lower breast cancer risk are tamoxifen and raloxifene. Other medicines called aromatase inhibitors (such as anastrozole and exemestane) might also be options.?

Should I take medicine to help reduce my breast cancer risk?

Before deciding if you should take medicine to help lower your chances of breast cancer, your healthcare provider should assess your breast cancer risk.

Most experts say that your breast cancer risk should be higher than average for you to consider taking one of these medicines. If you have a higher-than-average risk, you should compare the benefit of possibly reducing your chance of breast cancer with the risk of side effects and other problems from taking one of these medicines.

Are there reasons not to take medicine to help reduce breast cancer risk?

All medicines have risks and side effects that must be discussed when deciding whether to take them.

Most experts agree that tamoxifen and raloxifene should not be used to reduce breast cancer risk in women who:

• Have a higher risk of serious blood clots*
• Are pregnant or plan to become pregnant
• Are breastfeeding
• Are taking estrogen, including birth control pills or shots, or menopausal hormone therapy
• Are taking an aromatase inhibitor
• Are younger than 35 years old

*Women who have a higher risk of serious blood clots include those who have had serious blood clots. These include deep venous thrombosis (DVT) and pulmonary embolism (PE). You might have a higher risk of blood clots if:

• You’ve had a stroke or heart attack
• You smoke
• You have obesity
• You are being treated for high blood pressure or diabetes

If you have any of these conditions, ask your doctor if the benefits of taking one of these drugs would outweigh the risks.

A woman who has been diagnosed with any type of uterine cancer or atypical hyperplasia of the uterus (a kind of pre-cancer) should not take tamoxifen to help lower breast cancer risk.

Raloxifene has not been tested in pre-menopausal women. It should only be used if you have reached menopause.

Aromatase inhibitors should only be used if you have reached menopause, unless it is used as a part of a clinical trial. These drugs can cause bone thinning (osteoporosis), so they’re not likely to be a good option in people who already have thin or weakened bones.

Talk with your doctor about your overall health to make the best possible choice for you.

More resources

Learn more about the use of these medicines for chemoprevention.