I have a 74 yo patient that has history of left breast cancer in 1997 s/p unilateral left mastectomy and chemo and radiation and tamoxifen, she was recently diagnosed with ALH, ADH , and adjacent intraductal papilloma,
given her age of 74 would you recommend risk reducing meds? last dexa was normal in 2016, uterus intact
if so would you have a preference for raloxifene vs AI?
genetic testing was done in 2010 and repeated in 2013 for BRCA and negative.

Expert Response: Guidelines in general do not recommend prescribing preventive medication after age 75 as the risks outweigh the benefits. I would get another dexa now. If the patient wants to take medication and is otherwise healthy, based on the Dexa – if osteoporosis- recommend Raloxifene x 5 years AND if osteopenia or within normal, I would recommend exemestane. She can take the AI for 5 years but get a BMD annually.