First cancer prevention drug set for PBS listing

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A drug to prevent, rather than treat, cancer is set to be listed on the PBS for the first time


A drug to prevent, rather than treat, cancer is set to be listed on the PBS for the first time, following the positive recommendation of tamoxifen for breast cancer prevention

Once listed, it is expected the drug will be available as a restricted benefit for women at moderately increased risk (1.5 to three times the population average) or high risk (greater than three times the population average) of the disease.

The recommendation was based on a meta-analysis of four head-to-head trials comparing tamoxifen to placebo, which showed that for 1000 women treated for 10 years, 14 breast cancers would be prevented.

According to Cancer Australia, risk should be determined on the basis of family history, and key factors associated with increased risk include multiple relatives affected by breast cancer, younger age at cancer diagnosis in relatives, having a relative with an identified mutation in a high-risk breast cancer gene and having relatives affected with bilateral breast cancer.

Doctors can use an online tool “Familial Risk Assessment – Breast and Ovarian Cancer” to determine a patient’s risk:

Cancer Council Australia chief executive, Professor Sanchia Aranda, said the PBS listing of tamoxifen provided one more option for women at high risk of breast cancer. “It sits alongside options such as preventative mastectomies, which is another way of lowering your risk of getting breast cancer,” she said.

“But also it causes general side effects that we understand from hormone regulating drugs – so hot flushes, depression, loss of libido.”

Other possible side effects included a higher risk of endometrial cancer, bone loss in premenopausal women, and thromboembolic phenomena in individuals with a family history of these disorders, she said.

“We know from the women who have been in studies using tamoxifen for recurrence that many women stop taking the drug because of the side effects, so it’s not just a simple decision to take.”

The Australia and New Zealand Breast Cancer Trials Group, which conducted clinical trials using tamoxifen, said approximately 250,000 women will gain access to the drug through the PBS listing.

“Not only will Australian women have access to subsidised Nolvadex to reduce their lifetime risk of developing breast cancer, but there will also be a reduced cost to the health system with less women needing breast cancer treatments,” the group said.

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