Medical Oncologist
CION Cancer Clinics
Tamoxifen and raloxifene: tablets to lower breast cancer risk | CION Cancer Clinics
Tamoxifen and raloxifene are daily tablets that can lower the chance of the most common type of breast cancer in women at raised risk. They do not suit everyone, and they are not the same as treatment after a cancer. This page explains how they work, who they are offered to, the side effects to weigh, and why the evidence in BRCA carriers is thinner than families expect. At CION Cancer Clinics, our team helps carriers and their families plan checks, next steps and support after a genetic result.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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On this page
- Can a daily tablet really lower breast cancer risk?
- Tamoxifen or raloxifene: how do the two differ?
- What happens if you decide to take one?
- The terms your doctor may use, in plain language
- Who may benefit, and who should think twice
- What this page cannot tell you
- Four things women tell us, and what is actually true
- Common questions about tamoxifen and raloxifene
The short answer
Can a daily tablet really lower breast cancer risk?
Yes, for some women. Tamoxifen and raloxifene lower the chance of the most common type of breast cancer, the kind that grows in response to oestrogen. They do not remove the risk, and they do nothing for breast cancers that ignore oestrogen.
How the tablets work
Oestrogen is the body's own hormone. It can act like fuel for many breast cancers. Both tablets sit on the parts of breast cells that oestrogen normally switches on, and block the signal. A cell that is not being pushed to grow is less likely to become a tumour.
Who they are usually offered to
Women whose risk is clearly raised by a strong family history, a gene fault, or certain changes found on an earlier breast biopsy. They are not offered to women at average risk, because the side effects would outweigh a very small gain.
Where the evidence is thin
The large trials were run in women with a family history, not specifically in BRCA carriers. Breast cancers in BRCA1 carriers usually ignore oestrogen, so the benefit there is uncertain. Cancers in BRCA2 carriers more often respond to oestrogen, which makes the case stronger.
These are preventive tablets for well women. They are not the same decision as hormone treatment after a breast cancer.Two tablets compared
Tamoxifen or raloxifene: how do the two differ?
They work in a similar way. The main difference is who can take each one.
Tamoxifen
Used for decades, cheap and widely available in India as a generic tablet. It can be taken before or after menopause, which makes it the usual choice for younger women.
Main trade-offs
- Hot flushes and irregular periods
- A small rise in the chance of a blood clot
- A small rise in womb cancer risk after menopause
Raloxifene
First made to protect bones after menopause. It is only used in women whose periods have stopped. It does not raise the risk of womb cancer.
Main trade-offs
- Hot flushes and leg cramps
- A small rise in the chance of a blood clot
- Somewhat less protection than tamoxifen in trials
What they share
Both are taken once a day for several years. Both are for women at raised risk only. Both need a doctor to check your history of clots and strokes before you start.
What neither does
Neither lowers the risk of ovarian cancer. Neither replaces surveillance scans. Neither changes the gene fault itself, which stays in every cell and can still be passed on.
Not sure whether this applies to you?
Ask an oncologistFrom first talk to last tablet
What happens if you decide to take one?
-
Your risk is worked out properly
A genetic counsellor or oncologist looks at your gene result, your family tree and your age. The tablet only makes sense if your risk is clearly above average.
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Your health is checked for reasons not to start
You will be asked about past blood clots, strokes, womb problems and pregnancy plans. You will also be asked about other medicines, including some antidepressants that can weaken tamoxifen.
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You start the tablet
One tablet a day, at the same time each day. Women taking tamoxifen before menopause need a non-hormonal method of contraception, because the drug is not safe in pregnancy.
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You are reviewed after the first few months
This is when side effects are usually clearest. Many settle. If they do not, switching or stopping is a normal outcome and not a failure.
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You finish the course
The usual course lasts about five years. In trials, the protection carried on for many years after the tablets stopped, which is part of why the course is not lifelong.
Words you will hear
The terms your doctor may use, in plain language
- Chemoprevention
- Using a medicine to lower the chance of a cancer starting. It is not chemotherapy and it does not cause hair loss.
- SERM
- The drug family both tablets belong to. They block oestrogen in some parts of the body and copy it in others.
- Oestrogen-sensitive cancer
- A breast cancer that grows in response to oestrogen. This is the only kind these tablets protect against.
- Menopause status
- Whether your periods have stopped for good. It decides which of the two tablets you can take.
- Blood clot
- A clot in a deep vein, usually in the leg, that can travel to the lungs. It is uncommon but it is the most serious risk.
- Carry-over effect
- Protection that continues after the course of tablets has ended.
Side by side
Who may benefit, and who should think twice
Often worth discussing
Usually not advised
A BRCA2 or other gene fault linked to oestrogen-sensitive cancer
Average risk, with no strong family history
A strong family history with no fault found
A past blood clot or stroke
Atypical cells found on a previous biopsy
Pregnant, or trying to become pregnant
Keeping your breasts and choosing to delay surgery
After both breasts have been removed
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Being straight with you
What this page cannot tell you
It cannot tell you whether a tablet is right for you. That depends on your exact gene result, your age, your menopause status, your other health problems and how you weigh side effects against benefit. What your specific variant means is a question for the counsellor who ordered the test.
It cannot give you your number
Trials report the average benefit across thousands of women. Your own gain may be larger or smaller. Ask your doctor to explain your risk with and without the tablet, in words you can repeat to your family.
Who this does not apply to
Most women do not need these tablets. They are not advised for men, for women at average risk, or for anyone who has had both breasts removed. BRCA1 carriers should also know the benefit for them is not proven.
Never start tamoxifen or raloxifene from a pharmacy on your own. Both need a prescription and a proper check first.Commonly believed
Four things women tell us, and what is actually true
"Tamoxifen is chemotherapy, so my hair will fall out."
It is a hormone-blocking tablet, not chemotherapy. It does not cause the hair loss, sickness or low blood counts people link with chemotherapy.
"If I take the tablet, I can skip my scans."
The tablet lowers risk. It does not remove it. Your breast MRI or mammogram schedule carries on exactly as planned, because some cancers will still occur.
"The side effects are so bad that nobody finishes."
Many women find the side effects manageable, and many settle after the first few months. Some women do stop, and that is a reasonable choice made with the doctor.
"It also protects my ovaries."
It does not. Neither tablet lowers ovarian cancer risk. For BRCA carriers, ovarian risk is a separate conversation about surgery and timing.
Questions we are asked
Common questions about tamoxifen and raloxifene
Does tamoxifen work for BRCA1 carriers?
It is not proven. Most breast cancers in BRCA1 carriers do not respond to oestrogen, so a tablet that blocks oestrogen may do little. Some doctors still discuss it. Ask your oncologist to explain how the evidence applies to your own result.
How long do I take the tablet for?
The usual course is about five years. Trials suggest the protection lasts well beyond the last tablet. Your doctor may adjust this if side effects are hard or if your situation changes.
Can I get pregnant while taking tamoxifen?
You should not. Tamoxifen can harm a developing baby. Use a barrier method or a copper coil, not the hormonal pill, and tell your doctor early if you are planning a family. You will be told how long to wait after stopping.
Is tamoxifen expensive in India?
No. It is an old generic medicine and one of the cheaper tablets in cancer care. Raloxifene is also sold as a bone medicine. The larger cost is usually the checks and follow-up visits, not the tablet itself.
Can I take it alongside surveillance scans?
Yes, and you should. The tablet and the scans do different jobs. One lowers the chance of a cancer. The other finds a cancer early if one still develops.
What symptoms should make me call the doctor?
A painful, swollen calf, sudden breathlessness or chest pain need urgent attention, because they can mean a clot. Any bleeding from the vagina after menopause should also be checked promptly. Do not wait for your next review.
Is there anything newer than these two?
Aromatase inhibitors are another option for women after menopause. A lower-dose form of tamoxifen is also being studied, with fewer side effects. Evidence in gene carriers for both is still limited.
Who should I talk to first?
Start with the genetic counsellor or oncologist who is managing your risk. Bring your gene report, a list of your medicines and any history of clots. Call the CION helpline if you are not sure which clinic to approach.
Your Specialists
Meet CION's oncologists. Bring your family history or genetic report to them.
Our medical oncologists see people with a strong family history of cancer, arrange genetic counselling and testing where it fits, and plan the checks that follow.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
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Sources
- National Cancer Institute — Breast Cancer Prevention (PDQ) - Patient Version
- NICE — Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer (CG164)
- NHS — Tamoxifen
- National Cancer Institute — Genetics of Breast and Gynecologic Cancers (PDQ) - Health Professional Version
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Chemoprevention explainedThe bigger picture of using medicine to lower riskAromatase inhibitors for preventionThe other tablet option for women after menopauseSide effects of preventive hormone medicationWhat to expect, and what to report quicklySurgery, medication or surveillance: how to weigh themWhere a tablet fits beside the other choices
Talk to us
Wondering whether a preventive tablet makes sense for you?
Bring your gene report and your family history, and we will help you understand whether tamoxifen or raloxifene is worth discussing. There is no pressure to decide on the day. One helpline serves every CION centre.