I’m a breast cancer specialist and these are the cheap tablets every midlife woman should take to ward off the disease – on top of HRT… and they can protect your heart and keep dementia at bay, too

Midlife women should be offered a trio of cheap drugs that could dramatically reduce their risk of breast cancer, protect their hearts and potentially help ward off dementia, a leading cancer expert has said.

Speaking to the Daily Mail, Dr Andrea De Censi said women should be offered hormone replacement therapy (HRT), a low dose of the cancer-preventing drug tamoxifen and, where appropriate, cholesterol-lowering statins.

He believes the treatments could be offered when women attend their first routine breast cancer screening, at the age of 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 believes the approach could lift the ‘dark shadow’ that has hung over women’s health for decades, by tackling debilitating menopausal symptoms while offering protection against some of the biggest killers of older women.

However, the inclusion of tamoxifen, in particular, is likely to prove controversial.

The drug works by blocking the effects of the female hormone oestrogen, which fuels the growth of many breast cancers. It is routinely prescribed to women who have already had breast cancer to reduce the risk of the disease returning.

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

But uptake remains stubbornly low, with fewer than one in seven eligible women taking it.

This is partly due to concerns about side effects, which can include menopause-like 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 specialists who argue that low-dose tamoxifen – dubbed ‘baby tam’ – should be offered much more widely to women aged 50 and over, even those who are not considered at particularly high risk of breast cancer.

Research suggests that taking the drug for five years could reduce a woman’s risk of developing breast cancer by around a fifth over the following decade.

Dr De Censi believes prescribing the pill, which costs just 45p-a-dose, could offer a simple, inexpensive way of preventing the disease.

He argues that women taking ‘baby tam’ receive roughly a quarter of the standard dose and typically experience far fewer side effects – perhaps as little as one hot flush a day.

The need for better ways to prevent breast cancer is clear.

Around 59,000 women are diagnosed with the disease in the UK every year. And while advances in treatment have dramatically improved survival rates in recent decades, breast cancer still claims more than 11,000 lives annually.

There are steps women can take to reduce their risk, including maintaining a healthy weight, exercising regularly and limiting alcohol intake.

But Dr De Censi believes more should be done to protect women as they reach the age when their risk of developing the disease begins to rise sharply.

Not everyone is convinced that prescribing tamoxifen more widely is the answer, however.

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

And some experts have questioned whether even the lower dose could cause side effects severe enough to outweigh the benefits of giving the drug to otherwise healthy women.

But Dr De Censi believes the potential benefits become even greater when tamoxifen is prescribed alongside HRT.

For decades, millions of women have been reluctant to take HRT because of fears that it could increase their risk of breast cancer.

The concerns intensified following the publication of a major study, the Women’s Health Initiative, in 2002, which linked certain forms of HRT to an increased risk of breast cancer and cardiovascular problems.

Dr De Censi says the findings effectively brought an end to a trial he was conducting at the time, involving around 2,000 women, which was investigating whether tamoxifen could help protect against the breast cancer risk associated with HRT.

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

Now, he believes the time has come to revisit the idea.

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

The theory is that women could benefit from HRT’s ability to relieve menopausal symptoms, including hot flushes, insomnia and mood changes, while tamoxifen helps counter the potential increase in breast cancer risk.

And Dr De Censi believes the benefits of HRT could extend much further.

Some research suggests that women who begin HRT around the time of menopause may have a lower risk of cardiovascular disease, while other studies have suggested possible benefits for brain health and dementia risk.

However, the evidence remains mixed, particularly when it comes to dementia, and HRT is not currently recommended specifically to prevent either condition.

Dr De Censi nevertheless believes the growing body of research justifies 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 who use certain forms of HRT, including skin patches and gels, may have lower overall mortality rates.

One large Danish study, he says, found an association with a 15 to 20 per cent reduction in deaths, although such observational findings cannot establish that HRT itself was responsible.

‘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 element of his proposed treatment plan is a very low dose of statins, which are already widely prescribed to lower cholesterol and reduce the risk of heart attacks and strokes.

Dr De Censi suggests women with raised cholesterol could be offered what he calls ‘baby statins’ – half the lowest licensed dose, taken every other day.

He believes this could help overcome concerns about potential side effects, which can include muscle pain, weakness and digestive problems.

Intriguingly, some studies have also suggested that statins may offer protection against breast cancer, with research linking their use to a lower risk of the disease returning in women who have already been treated. However, there is less evidence that they prevent breast cancer from developing in the first place. 

Low-dose statins are also not an established standard regimen, and it remains unclear whether such an approach would provide sufficient protection against heart attacks and strokes.

He envisages women beginning the treatments in their 50s, taking low-dose tamoxifen for five years and potentially continuing HRT for a decade.

The approach would not replace the importance of a healthy lifestyle, he stresses.

‘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 combination remains a proposal rather than an established medical recommendation. In particular, larger trials would be needed to establish whether combining HRT and low-dose tamoxifen offers the protection Dr De Censi hopes for.

But he believes the potential to tackle several of the major health problems facing women in later life at once is too important to ignore.

‘That’s how I see the future,’ he said.