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Systematic review
Tamoxifen, raloxifene and tibolone decrease risk of invasive breast cancer in healthy women but increase risk of thromboembolism (tamoxifen, raloxifene), endometrial cancer (tamoxifen) or stroke (tibolone)
  1. Victor G Vogel
  1. Correspondence to Victor G Vogel
    American Cancer Society, 250 Williams Street, Atlanta, GA 30303, USA; victor.vogel{at}

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Women who are at increased risk for breast cancer can be easily identified in clinical practice and may have very high lifetime probabilities of developing invasive breast cancer. Nelson and colleagues conducted a meta-analysis of eight clinical trials that examined the ability of selective oestrogen receptor modulators (SERMs) or tibolone to reduce the risk of invasive breast cancer in both premenopausal and postmenopausal women at various levels of risk of breast cancer. Tamoxifen and raloxifene are associated with a significant reduction in the risk of oestrogen receptor-positive invasive breast cancer. Tamoxifen is effective in both younger and older women, although side effects increase with age.

The authors state that data are lacking on doses, duration, timing and long-term side effects, although this statement is not entirely accurate. While it is true that only 20 …

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  • Competing interests VGV was the protocol chairman for the NSABP Study of Tamoxifen and Raloxifene and an investigator for the NSABP Breast Cancer Prevention Trial, both included in the meta-analysis reviewed here.