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Chemoprevention of Breast Cancer with Selective Estrogen Receptor Modulators

Roshani Patel and V Craig Jordan

Thirty years ago, there were no practical measures available in clinical practice to reduce the incidence of breast cancer in women. Today, through effective translational research, scientific principles from the laboratory have enhanced patient options to reduce their risk of developing breast cancer. Tamoxifen and raloxifene are selective estrogen receptor (ER) modulators (SERMs) that are estrogen-like and enhance bone density in postmenopausal women, but are also antiestrogenic and prevent breast cancer growth and development. Clinical studies have demonstrated that tamoxifen is safe and effective in reducing the incidence of breast cancer in premenopausal high-risk women. However, tamoxifen increases the risk of endometrial cancer in postmenopausal high-risk women. Raloxifene represents a useful and safe alternative chemopreventive therapy that does not elevate the incidence of endometrial cancer in postmenopausal women. Most importantly, the use of raloxifene to prevent osteoporosis in osteopenic postmenopausal women has the added advantage of preventing breast cancer and endometrial cancer as a beneficial side effect. This article will review the history of chemoprevention in breast cancer from concept to clinical practice.

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