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Reviews in Endocrine and Metabolic Disorders

, Volume 8, Issue 3, pp 229–239 | Cite as

SERMs for the treatment and prevention of breast cancer

  • Ramona F. Swaby
  • Catherine G. N. Sharma
  • V. Craig Jordan
Article

Abstract

Tamoxifen and raloxifene are both selective estrogen receptor modulators (SERMs). The medicines can block estrogen mediated breast cancer growth and development but will also maintain bone density in postmenopausal women and lower circulating cholesterol. Tamoxifen has remained the antihormonal therapy of choice for the treatment of ER positive breast cancer for the last 30 years. However, although adjuvant tamoxifen produces profound increases in disease-free and overall survival in patients with ER positive breast cancer, concerns about drug resistance, blood clots and endometrial cancer have resulted in a change to the use of aromatase inhibitors for the treatment of postmenopausal women. Nevertheless, tamoxifen remains the antihormonal treatment of choice for premenopausal women with ER positive breast cancer and for risk reduction in premenopausal women who are at high risk for developing breast cancer. The risk of endometrial cancer and thromboembolic disorders during tamoxifen therapy is not elevated in premenopausal women. It is important to note that aromatase inhibitors or raloxifene should not be used in premenopausal women. Raloxifene is used to prevent osteoporosis in postmenopausal women and, unlike tamoxifen, does not increase the risk of endometrial cancer. However, raloxifene does reduce breast cancer risk by 50–70% in both low risk and high risk postmenopausal women. Comparisons of raloxifene with tamoxifen show equal efficacy as a chemopreventive for breast cancer but there is a reduction in thromboembolic disorders, fewer endometrial cancers, hysterectomies, cataracts and cataract surgeries in women taking raloxifene. Overall, SERMs continue to fulfill their promise as appropriate medicines that target specific populations for the treatment and prevention of breast cancer.

Keywords

Tamoxifen Raloxifene Estrogen receptor Selective estrogen receptor modulator Osteoporosis Endometrial cancer 

Notes

Acknowledgements

This manuscript is supported by the Department of Defense Breast Program under award number BC050277 Center of Excellence(VCJ) (Views and opinions of, and endorsements by the author(s) do not reflect those of the US Army or the Department of Defense), SPORE in Breast Cancer CA 89018(VCJ), R01 GM067156(VCJ), FCCC Core Grant NIH P30 CA006927, the Avon Foundation(VCJ) and the Weg Fund of Fox Chase Cancer Center(VCJ). Dr. Swaby is also supported by the Fox Chase Intramural Translational Research Award.

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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Ramona F. Swaby
    • 1
  • Catherine G. N. Sharma
    • 1
  • V. Craig Jordan
    • 1
  1. 1.Fox Chase Cancer CenterPhiladelphiaUSA

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