Exemestane for primary prevention of breast cancer in postmenopausal women
Abstract
Purpose The benefits and risks of exemestane for the primary prevention of breast cancer are discussed and compared with other breast cancer chemoprevention therapies. Summary Selective estrogen-receptor modulators (SERMs) are the current mainstay for primary prevention of breast cancer. As an alternative, exemestane, an aromatase inhibitor, has been evaluated for breast cancer prevention in postmenopausal women. A study of 4560 high-risk postmenopausal women taking exemestane 25 mg daily for a median of three years found a 65% relative reduction in the annual occurrence of invasive breast cancer compared with placebo (0.19% versus 0.55%; hazard ratio, 0.35; 95% confidence interval [CI], 0.18-0.70; p = 0.002) and a 53% reduction in invasive plus noninvasive breast cancer (0.35% versus 0.77%; hazard ratio, 0.47; 95% CI, 0.27-0.79; p = 0.04). Adverse effects from exemestane are generally mild, with the most common being diarrhea, joint pain, and menopausal-related symptoms. Importantly, exemestane did not increase the risks of endometrial cancers, thromboembolism, cardiovascular events, or cataracts. However, joint stiffness and arthralgia were more common when compared with tamoxifen or raloxifene. Ongoing clinical trials with other aromatase inhibitors are underway to evaluate the benefits and long-term skeletal risks. Conclusion Exemestane 25 mg daily taken for at least three years is a new option for the prevention of breast cancer in high-risk postmenopausal women. Indirec…
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Both AI trials demonstrated a reduction in risk of ER-positive invasive breast cancer, but no significant effect on ER-negative disease.
“Notably, both trials demonstrated a reduction in the risk of estrogen receptor (ER)-positive invasive breast cancer, but no significant effect on ER-negative disease.”
From Screening, Risk Reduction Strategies, and Clinical Management of Unaffected Carriers of <i>BRCA1</i> or <i>BRCA2</i> Pathogenic Variants (2026) · cites this paper as [68]
In the MAP.3 trial, exemestane use was associated with significant reduction in invasive breast cancers in all study subgroups (HR 0.35, 95% CI 0.18-0.70).
“At a median follow-up of almost 3 years, exemestane use was associated with significant reduction in invasive breast cancers in all study subgroups (HR: 0.35, 95% CI: 0.18 - 0.70) [67, 68].”
From Screening, Risk Reduction Strategies, and Clinical Management of Unaffected Carriers of <i>BRCA1</i> or <i>BRCA2</i> Pathogenic Variants (2026) · cites this paper as [68]
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- Authors
- Zhang, Y., Simondsen, K., & Kolesar, J. M.
- Affiliations
- University of Wisconsin–Madison (US)
- Corresponding author
- Kolesar, Jill M.
- Venue
- American Journal of Health-System Pharmacy
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-08-15
- Volume
- 69
- Issue
- 16
- Pages
- 1384-1388
- ISSN
- 1079-2082 (ISSN-L)
- 1535-2900
- OpenAlex
- W1977637853
- Cited by
- 15
- References
- 14
- Citations by year
- 2026: 1 · 2023: 3 · 2022: 4 · 2021: 1 · 2020: 1 · 2016: 1 · 2015: 1 · 2014: 2 · 2013: 1
- FWCI
- 0.77
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Health-System Pharmacy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Estrogen and related hormone effects
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › Breast Cancer Treatment Studies
- Keywords
- exemestane, breast cancer chemoprevention, primary prevention, aromatase inhibitors, postmenopausal women, selective estrogen receptor modulators, tamoxifen, raloxifene, adverse effects, osteoporosis, thromboembolism, endometrial cancer, high-risk women
- MeSH terms
- Androstadienes, Breast Neoplasms, Estrogen Antagonists, Female, Humans, Middle Aged, Primary Prevention, Tamoxifen, Postmenopause, Risk Assessment, Chemoprevention, Antineoplastic Agents, Hormonal, Genetic Predisposition to Disease, Selective Estrogen Receptor Modulators, Raloxifene Hydrochloride, Aromatase Inhibitors
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