TY - JOUR T1 - 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) JF - Evidence Based Medicine JO - Evid Based Med SP - 122 LP - 122 DO - 10.1136/ebm1044 VL - 15 IS - 4 AU - Victor G Vogel Y1 - 2010/08/01 UR - http://ebm.bmj.com/content/15/4/122.abstract N2 - Commentary on: Nelson HD, Fu R, Griffin JC, et al. Systematic review: comparative effectiveness of medications to reduce risk for primary breast cancer. Ann Intern Med 2009;151:703–15, W–226–35.OpenUrlCrossRefPubMedWeb of Science 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 … ER -