Sr. Goldstein, Drugs for the gynecologist to prescribe in the prevention of breast cancer: Current status and future trends, AM J OBST G, 182(5), 2000, pp. 1121-1126
Tamoxifen was approved for breast cancer prevention in October 1998. Thus,
for the first time, we as gynecologists are being asked to prescribe this d
rug to healthy women. In the past each one of us has cared for women with b
reast cancer who have been treated with tamoxifen by oncologists or breast
surgeons for the malignancy. Effects of tamoxifen on the uterus resulting i
n carcinomas, hyperplasia, and polyps are well known, Furthermore, tamoxife
n has estrogenic properties in the venous system, increasing the incidence
of deep vein thrombosis and pulmonary emboli. A new SERM (selective estroge
n receptor modulator), raloxifene, has been approved for prevention and tre
atment of osteoporosis in postmenopausal women. It does not have stimulator
y effects on the endometrium; however, it is estrogenic in the venous syste
m. Preclinical data, as well as the breast cancer incidence reported in stu
dies of the skeleton, seem to indicate that its effects in the breast are s
imilar to those of tamoxifen. This article reviews tamoxifen and the new SE
RM, raloxifene, in an attempt to help gynecologists better understand each
compound and what data are currently known, what we hope to learn from futu
re studies, and what currently makes sense for clinical practice.