Can Evista Help Reduce Risk?
QUESTION: My oncologist recommended Evista for me to prevent recurrence of breast cancer. I am so afraid of the side effects, as I am already experiencing lots of discomfort from menopause. One side effect was blood clots, and my father died after an operation from a clot to his lung. Anything you can help me with will be so greatly appreciated. I was not a good candidate for tamoxifen.
ANSWER:Evista (chemical name: raloxifene) is a sister to tamoxifen — but tamoxifen has a much longer track record in women at risk of or with breast cancer.
Evista is an effective non-hormonal way to help keep bones strong after menopause. And, in postmenopausal women with osteoporosis (thin bones), Evista does more than just strengthen bones. It seems to reduce the risk of breast cancer in these women without increasing the risk of endometrial cancer. Tamoxifen has been around a lot longer and is tested and approved for women with hormone-receptive breast cancer and for women at high risk for the disease who have not had it themselves.
Evista has side effects similar to tamoxifen's. There is the relatively common and annoying side effect of hot flashes. A more serious side effect with both medications is a less than 1% risk of blood clots going to the lungs. (Your father's clot just after surgery probably represents a post-surgical complication, not a problem that would be passed down from father to daughter.) Studies to date indicate that the less than 1% risk of endometrial cancer associated with tamoxifen is not seen with Evista.
In September 2007, the U.S. Food and Drug Administration (FDA) approved using Evista to reduce the risk of breast cancer in post-menopausal women who are at high risk and in post-menopausal women with osteoporosis. If you are having second thoughts about taking Evista, you can get a second opinion to help clarify the issues in your individual situation. Be reassured that, as with all medications, doctors need to re-evaluate Evista along the way to make sure it's working for you and to see if the benefits outweigh the potential side effects. If you go on it and it's not meeting your needs, you can always stop!
—Marisa Weiss, M.D.
