Cancer expert urges cheap pill trio for midlife women to cut breast cancer risk, support heart health and help protect the brain

Midlife women should be offered a low-cost combination of medicines that could sharply cut their breast cancer risk, support heart health and may also help protect against dementia, a leading cancer specialist has said.

Dr Andrea De Censi told the Daily Mail that women should be given hormone replacement therapy (HRT), a low dose of the breast cancer-preventing drug tamoxifen and, when suitable, cholesterol-lowering statins.

He says the treatments could be discussed when women attend their first routine breast cancer screening at age 50.

“The HRT will cover the bones and the brain. You cover the muscles with exercise and resistance training. Then you cover your heart with baby statins,” he said.

“It's the perfect combination for longevity.”

The specialist says the strategy could lift the “dark shadow” that has hung over women’s health for decades by easing menopausal symptoms while also offering protection against some of the biggest causes of death in older women.

But the suggestion of adding tamoxifen, in particular, is likely to spark debate.

The drug blocks the effects of oestrogen, the female hormone that drives the growth of many breast cancers. It is routinely prescribed to women who have already had breast cancer to help reduce the risk of recurrence.

Women at high risk of the disease are also offered the medicine, after research showed it can help prevent breast cancer from developing in the first place.

Even so, take-up remains low, with fewer than one in seven eligible women choosing it.

Part of that reluctance stems from concerns about side effects, including hot flushes, joint pain, fatigue, weight gain and night sweats. The drug can also cause birth defects if taken during pregnancy.

Dr De Censi is among a growing group of experts arguing that low-dose tamoxifen, often called “baby tam”, should be offered far more widely to women aged 50 and over, including those not considered especially high risk.

Studies suggest that taking the drug for five years could reduce a woman’s risk of breast cancer by about a fifth over the following decade.

He says the tablet, which costs just 45p per dose, could be a simple and inexpensive way to help prevent the disease.

He argues that women taking “baby tam” receive around a quarter of the standard dose and usually experience far fewer side effects, perhaps as little as one hot flush a day.

The need for better prevention is clear.

About 59,000 women are diagnosed with breast cancer in the UK each year. And although treatment advances have greatly improved survival in recent decades, the disease still causes more than 11,000 deaths annually.

Women can reduce their risk by keeping a healthy weight, exercising regularly and limiting alcohol intake.

Still, Dr De Censi believes more should be done to protect women as they enter the years when their risk begins to rise sharply.

Not everyone agrees that wider prescribing of tamoxifen is the answer, though.

There is still limited evidence on how effective low-dose tamoxifen is for preventing breast cancer in women who are not already at increased risk.

Some experts have also questioned whether even the lower dose could trigger side effects serious enough to outweigh the benefits for otherwise healthy women.

Dr De Censi believes the potential gains become even greater when tamoxifen is combined with HRT.

For decades, many women have been hesitant to take HRT because they feared it might raise their breast cancer risk.

Those worries intensified after the publication of the Women’s Health Initiative study in 2002, which linked certain forms of HRT with a higher risk of breast cancer and cardiovascular problems.

Dr De Censi says those findings effectively ended a trial he was running at the time involving about 2,000 women, which was examining whether tamoxifen could help offset the breast cancer risk linked to HRT.

“It's something I did 20 years ago, but then the WHI study was published and killed my trial,” he said.

He now believes the idea deserves another look.

“I'm very interested in giving the benefits of hormone therapy but protecting the breast with baby tam,” he said.

The idea is that women could gain relief from menopausal symptoms such as hot flushes, insomnia and mood changes while tamoxifen helps counter any possible rise in breast cancer risk.

He also believes HRT may offer wider benefits.

Some studies suggest women who start HRT around menopause may have a lower risk of cardiovascular disease, while others point to possible benefits for brain health and dementia risk.

However, the evidence is still mixed, especially on dementia, and HRT is not currently recommended specifically to prevent either condition.

Even so, Dr De Censi says the growing body of research supports a broader approach to women’s health.

“My job is shifting from breast cancer prevention to a wider lens of women's health promotion,” he said.

“I want to consider the other causes of disease like cardiovascular disease, dementia, osteoporosis, sarcopenia [age-related muscle loss] and depression.”

He points in particular to research suggesting that women using some forms of HRT, including skin patches and gels, may have lower overall mortality.

One large Danish study, he says, found an association with a 15 to 20 per cent reduction in deaths, although observational studies cannot prove that HRT caused the effect.

“After 20 years of darkness, we can start again to offer postmenopausal hormone therapy to women who have gone through the menopause and are symptomatic,” he said.

The final part of his plan is a very low dose of statins, which are already commonly used to lower cholesterol and reduce the risk of heart attacks and strokes.

Dr De Censi suggests that women with high cholesterol could be offered what he calls “baby statins” — half the lowest licensed dose, taken every other day.

He believes that could ease fears about side effects such as muscle pain, weakness and digestive problems.

Some studies have also hinted that statins may protect against breast cancer, with research linking them to a lower risk of recurrence in women who have already been treated. But there is less evidence that they stop breast cancer developing in the first place.

Low-dose statins are not yet a standard regimen, and it is still unclear whether this approach would offer enough protection against heart attacks and strokes.

He sees women starting the treatments in their 50s, taking low-dose tamoxifen for five years and possibly continuing HRT for a decade.

He stresses that the approach would not replace healthy living.

“You can start by saying: I will change my lifestyle with diet, exercise, psychological counselling and meditation,” he said.

“And if you want treatments that are much more potent and fast, you can take HRT and baby tam.”

For now, the three-drug approach remains a proposal rather than a formal medical recommendation. Larger trials would still be needed to show whether combining HRT and low-dose tamoxifen provides the protection Dr De Censi hopes for.

But he believes the chance to address several major health threats facing older women at once is too important to ignore.

“That's how I see the future,” he said.