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This CME/CE activity is provided by PRIME Education, Inc. (PRIME®) and is accredited for a multi-disciplinary audience of health care practitioners. This activity is supported by contract number HHSA290201200021I from the Agency for Healthcare Research and Quality. User data collected through this activity will reside on PRIME's educational portal for use by AHRQ.

Comparative Effectiveness of Therapies for Reducing the Risk of Primary Breast Cancer: Guidance for Shared Decision Making

To Receive a Certificate for This Activity:

Course Image
  1. 1. Read the Program Overview on this page.
  2. 2. Review the Faculty Biographies, Accreditation Statements, and Disclosure tabs.
  3. 3. Access the Activity in full.
  4. 4. Complete the Post-Test & Evaluation.
  5. 5. A printable certificate will be available immediately following the activity.

Program Overview

Activity Description

Breast cancer is the most commonly diagnosed noncutaneous cancer among women in the United States. In 2010, more than 200,000 cases of invasive breast cancer were diagnosed, and nearly 40,000 women died from the disease. For women considered to be at high risk for primary breast cancer, leading oncology organizations have endorsed risk-reducing therapies. The options include tamoxifen and raloxifene, which are FDA approved for preventive use in selected groups of at-risk women and tibolone, which is not currently FDA approved. Clinical trials have demonstrated that all 3 medications significantly reduce the risk of developing the disease in women without pre-existing cancer. The trials have also indicated the nature and magnitude of harms associated with the 3 medications.

In 2009, the Agency for Healthcare Research and Quality (AHRQ) published a systematic review on the comparative effectiveness and safety of tamoxifen, raloxifene, and tibolone for reducing the risk of primary breast cancer in women.

Toward the goal of informed and shared decision making, this patient-centered educational program guides clinicians in discussing AHRQ's findings with women who may be candidates for FDA-approved therapies for reducing the risk of primary breast cancer.

Learning Objectives

At the conclusion of this activity, the participant should be able to:

  • Compare the effectiveness of tamoxifen, raloxifene, and tibolone in the general population and specific subpopulations of at-risk women
  • Evaluate key differences in side effects, harms, persistence, and adherence associated with tamoxifen, raloxifene, and tibolone
  • Apply the findings in clinical settings to help at-risk women make informed and shared decisions about whether to use risk-reducing medications

Target Audience

This CME activity is designed to meet the educational needs of physicians, nurse practitioners, physician assistants, pharmacists, nurses, case managers, health educators and medical assistants.

Method of Participation

To receive a certificate for this activity, you should:

  • Complete the learner assessment pretest
  • View the entire activity online
  • Complete an online evaluation & post-test
  • Print your certificate online

The estimated time to complete this activity, including review of the materials, is 1.0 hour.

Term of Approval

July 29, 2011 through October 14, 2014. Original release date: July 29, 2011.

Acknowledgement of Support

There is no fee for this CME/CE activity. This activity is sponsored by PRIME Education, Inc (PRIME®) and funded under contract HHSA290201200021I from the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services (HHS).

Faculty Biographies and Disclosures

Click faculty name to view full biography.

Speaker

Therese B Bevers, MD, FAAFP
Chair of Cancer Screening & Diagnostic Guideline Panel
Professor, Department of Clinical Cancer Prevention
Division of OVP, Cancer Prevention & Populations Services
Medical Director, Cancer Prevention Center & Prevention Outreach Programs
The University of Texas MD Anderson Cancer Center
Houston, Texas 

Planner

Carolyn LePage, PhD, ARNP
Assistant Professor
Barry University School of Nursing
Miami Shores, FL

Planner

Heidi Wynn Maloni, PhD, ANP-BC, CNRN, MSCN
National Clinical Nursing Director
Department of Neurology
Multiple Sclerosis Center of Excellence, East Veterans Affairs Medical Center
Adjunct Faculty
Trinity Nursing Program School of Professional Studies, Trinity Washington University
Clinical Preceptor and Instructor
Advanced Practice Programs, The Catholic University of America School of Nursing
Washington, DC

Planner

Michele B Kaufman, PharmD, CGP, RPh
President, PRN Communications Inc.
Editor, Pharmacovigilance Forum, P&T Journal
NYCSHP Secretary
Adjunct Faculty
Touro College of Pharmacy
New York, NY

Planner

Wanda F Carter, MPH, CHES
Community Collaboration Manager
Wellpoint, Inc
Adjunct Professor, Axia College (U of Phoenix) Health Care Administration Program
Adjunct Professor, Ashford University Health Care Administration Program
PHPS Alumnus, CDC Scientific Education and Professional Development Program Office
Lawrenceville, GA

Peer Reviewer

Donna M Chiefari, BSc (Pharm), PharmD, RPh, FASHP
Adjunct Faculty & Preceptor
Albany College of Pharmacy
Albany, NY

Peer Reviewer

Joyce M Knestrick, PhD, CRNP, FAANP
Online Program Director
Associate Professor Georgetown University
Family Nurse Practitioner at Wheeling Health Right
Wheeling, WV

Peer Reviewer

Kathleen A Jarvis, MS, RN, CCM
Clinical Educator
Alere Healthcare
Fort Lauderdale, FL

Peer Reviewer

Sherman Podolsky, MD
Medical Director
Superior HealthPlan
Former Chairman
Department of Emergency Medicine
Albert Einstein Medical Center
Philadelphia, PA

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Accreditation/Credit Designation

Physician Credit Designation Statement

A C C M E Logo

PRIME Education, Inc. (PRIME®) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

PRIME® designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit. Physicians should claim only credit commensurate with the extent of their participation in the activity.

Physician Assistant Accreditation Statement

AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME. Physician assistants may receive a maximum of 1.0 hours of Category I credit for completing this program.

Nurse Practitioner Accreditation Statement

Nurse Practitioner Logo

PRIME Education, Inc (PRIME®) is approved as a provider of Nurse Practitioner Continuing Education by the American Association of Nurse Practitioners. Provider number: 060815. This program is accredited for 1.0 contact hour, which includes .25 hour of pharmacology. Program ID# CER10.

This program was planned in accordance with AANP CE Standards and Policies and AANP Commercial Support Standards.

Pharmacist Accreditation StatementA C P E Logo

PRIME® is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This curriculum has been approved for 1.0 contact hour (0.1 CEUs) by PRIME®. The Universal Activity Number for this program is 0255-0000-13-027-H01-P. This learning activity is Knowledge-Based.

Nurse Accreditation StatementA N C C Logo

PRIME Education, Inc. (PRIME®) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

PRIME® designates this activity for 1.0 contact hour.

Medical Assistant Accreditation Statement

This program has been granted prior approval by the American Association of Medical Assistants (AAMA) for 1.0 Continuing Education unit. Approval #125193. Granting approval in no way constitutes endorsement by the AAMA of the program content or the program's sponsor.

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Faculty Disclosures

Faculty Name
Advisory Board Consultant Grants / Research Salary / Contractual Supported Promotional Education Stock / Shareholder Other Financial Support
Therese B Bevers, MD, FAAFP
Speaker
None None Star Trial PI MD Anderson None None None None
Carolyn LePage, PhD, ARNP
Planner
None None None Barry University None None None
Heidi Wynn Maloni, PhD, ANP-BC, CNRN, MSCN
Planner
None None None None None None None
Michele B Kaufman, PharmD, CGP, RPh
Planner
None None None None None None None
Wanda F Carter, MPH, CHES
Planner
None None None None None None None
Donna M Chiefari, BSc (Pharm), PharmD, RPh, FASHP
Reviewer
None None None None None None None
Joyce M Knestrick, PhD, CRNP, FAANP
Reviewer
None None None None None None None
Kathleen A Jarvis, MS, RN, CCM
Reviewer
None None None None None None None
Sherman Podolsky, MD
Reviewer
None None None None None None None
Chris R Prostko, PhD
Scientific Program Director
NoneNoneNonePRIME®NoneNoneNone
Lynn Goldenberg, RN, BSN
Director of Accreditation & Compliance
NoneNoneNonePRIME®NoneNoneNone

Disclosure Policy

PRIME Education Inc (PRIME®) endorses the standards of the ACCME, as well as those of the AANP, ANCC and ACPE, that require everyone in a position to control the content of a CME/CE activity to disclose all financial relationships with commercial interests that are related to the content of the CME/CE activity. CME/CE activities must be balanced, independent of commercial bias and promote improvements or quality in healthcare. All recommendations involving clinical medicine must be based on evidence accepted within the medical profession.

A conflict of interest is created when individuals in a position to control the content of CME/CE have a relevant financial relationship with a commercial interest which therefore may bias his/her opinion and teaching. This may include receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, stocks or other financial benefits.

PRIME® willidentify, review and resolve all conflicts of interest that speakers, authors, course directors, planners, peer reviewers, or relevant staff disclose prior to an educational activity being delivered to learners. Disclosure of a relationship is not intended to suggest or condone bias in any presentation but is made to provide participants with information that might be of potential importance to their evaluation of a presentation. Disclosure information for speakers, authors, course directors, planners, peer reviewers, and/or relevant staff are provided with this activity.

Presentations that provide information in whole or in part related to non FDA approved uses of drugs and/or devices will disclose the unlabeled indications or the investigational nature of their proposed uses to the audience. Participants should refer to the official prescribing information for each product for discussion of approved indications, contraindications and warnings. Participants should verify all information and data before treating patients or employing any therapies prescribed in this educational activity. The opinions expressed in the educational activity are those of the presenting faculty and do not necessarily represent the views of PRIME®, the ACCME, AANP, ACPE, ANCC and other relevant accreditation bodies.

Content validation methods are consistently utilized by PRIME® to ensure that all program content is evidence-based, fair-balanced, and developed with scientific rigor and integrity. All clinical recommendations are based on evidence accepted within the medical profession. All scientific research referred to, reported or used to support a clinical recommendation conforms to accepted standards of experimental design, data collection and analysis. In addition to review of content by course directors and expert faculty, content is also validated through independent peer reviewers selected for their expertise in the content area, as well as their experience in the intended audience. All peer reviewers, planners, course directors, faculty and relevant staff utilized by PRIME® complete disclosures which are related to their role in the educational activity.

Accessibility

PRIME®is committed to providing access to our CME programs for individuals with disabilities as identified in Section 508 of the Rehabilitation Act for all web-based programs. This website is 508 compliant.

Begin Activity

Pretest

To access the activity, please complete this brief Pretest.

  • Returning user? Login Here!
  1. Before accessing this educational program, were you aware of the AHRQ-supported comparative effectiveness research on therapies to reduce the risk of primary breast cancer?

  2. In AHRQ’s systematic review on therapies to reduce the risk of primary breast cancer, tamoxifen and raloxifene significantly reduced the risk of ________.

  3. Which of the following factors is used in the Gail Model for determining the probability of developing breast cancer in women?

  4. What is the mechanism of action by which tamoxifen and raloxifene inhibit breast cell proliferation?

  5. According to AHRQ’s systematic review, which of the following therapies are associated with an increased risk of endometrial cancer?

  6. How would you describe your current level of confidence in applying comparative effectiveness research to your practice?

  7. How valuable is comparative effectiveness research for educating patients about treatment and management options?

  8. If you had clinician/consumer guides on primary breast cancer, what would you most likely do?

  9. DH, a 65-year-old female, met with her primary care physician for her annual check-up. During the visit, DH mentioned that her mother had recently passed away from breast cancer and that she was worried about her own risk of developing the disease. The physician informed DH that the Gail model is a tool used to determine a woman’s lifetime risk of developing breast cancer and for selecting candidates for risk-reducing therapy. Which of the following factors would you discuss with DH when assessing her risk of developing breast cancer based on the Gail model? Check all that apply.

Post-Test & Evaluation

You must access the activity before receiving credit!

Clinician & Consumer Summaries on Breast Cancer

Download these free summaries for your reference and/or patient handouts. You may also order bulk copies free of charge from the AHRQ Publication Clearinghouse below.

AHRQ Clearinghouse Bulk Order Form

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  • (Limit 200)
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  • Alternatively, you can call the AHRQ Publications Clearinghouse at 1-800-358-9295. Reference the title and product number above.