Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ BACK PAIN, LOW +++ Population ++ – Adults. +++ Recommendation +++ AAFP 2004, USPSTF 2004 ++ – Insufficient evidence for or against interventions to prevent low-back pain in adults in primary care settings. +++ Sources ++ – AAFP. Clinical Recommendations: Low Back Pain. 2004. – USPSTF. Low Back Pain. 2004. +++ Comments ++ Insufficient evidence to support back strengthening exercises, mechanical supports, or increased physical activity to prevent low-back pain. Meta-analyses in Lancet 2018;391:2368-2383, Am J Epidemiol. 2018;187(5):1093-1101, and JAMA Intern Med. 2016;176(2):199-208: Exercise alone or exercise in combination with education is effective for preventing low-back pain. Education alone, back belts, and shoe insoles are not effective. Exercises that were studied and shown to be effective are a combination of strengthening with either stretching or aerobic exercise, 2–3 times/wk. +++ BREAST CANCER +++ Population ++ – Adult women. +++ Recommendations +++ NCCN 2019 ++ – If a woman is at high risk secondary to a strong family history or very early onset of breast or ovarian cancer, offer genetic counseling. – Lifestyle Limit alcohol consumption. 4 drinks per day increases relative risk 1.32. Exercise: at least 150 min/wk of moderate intensity, or at least 75 min/wk of vigorous aerobic physical activity. Weight control. Relative risk 2.8 if weight >82 kg vs. <59 kg. Breast-feeding. Relative risk decreases 4% for every year of breast-feeding. Pregnancy. Pregnancy <20 y carries 50% risk reduction vs. first pregnancy after age 35. Each pregnancy reduces risk 7%. Combined estrogen/progesterone therapy (≥3–5 y duration of use raises incidence by 26%). – Risk-reducing agents for high-risk patients: Discuss relative and absolute risk reducing with tamoxifen, raloxifene, or aromatase inhibitors. Treatment with tamoxifen for 5 y reduced breast CA risk by 40%–50%. (Ann Intern Med. 2013;159:698-718). Meta-analysis shows RR = 2.4 (95% confidence interval [CI], 1.5–4.0) for endometrial CA and 1.9 (95% CI, 1.4–2.6) for venous thromboembolic events. Raloxifene has similar effect & risk as tamoxifen, except no reduction in noninvasive tumor and no increased risk of endometrial CA or cataracts (Lancet. 2013;381:1827). Aromatase inhibitor use as a prevention of breast cancer will reduce the risk of developing breast cancer by 3%–5% (Lancet. 2014;383:1041). Harmful effects include decreased bone mineral density and increased risk of fracture, hot flashes, increased falls, decreased cognitive function, fibromyalgia, and carpal tunnel syndrome but no life-threatening side effects. – Contraindications to tamoxifen or raloxifene: history of deep vein thrombosis, pulmonary embolus, thrombotic stroke, transient ischemic attack, or known inherited clotting trait. – Contraindications to tamoxifen, raloxifene, and aromatase inhibitors: current pregnancy or pregnancy potential without effective nonhormonal method of contraception. Common and serious adverse effects of tamoxifen, raloxifene, or aromatase ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth