January 2002 · Vol. 14, No. 1SERMs: Protection without worry?
The fear of breast cancer—and its link to estrogen use—causes many women to decline or discontinue estrogen replacement therapy. SERMs offer many of the same benefits with fewer risks, broadening the options for protecting long-term health.
ANTHONY
A.
LUCIANO,
MDDr. Luciano is professor of OBG at the University of Connecticut School of Medicine and director of the Center for Fertility and Women’s Health, New Britain General Hospital
New Britain, Conn.
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Key points
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Among ER-positive breast cancer patients treated with tamoxifen for 5 years, the annual recurrence rate is cut in half and the annual death rate is reduced by 28%.
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Tamoxifen has been shown to reduce the incidence of breast cancer by 44%, 51%, and 55% in women aged 35 to 49, 50 to 59, and 60 and older, respectively.
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Raloxifene mimics the effects of estrogen on the skeleton and lipids, but acts as a complete estrogen antagonist in the breast and uterus.
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Recent data indicate that 4 years of raloxifene therapy reduces the risk of all ER-positive breast cancers by 72% compared with placebo.
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The ideal candidate for raloxifene is a postmenopausal woman with osteopenia or osteoporosis, no increased risk of thromboembolism, and few or no vasomotor symptoms.
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Although it was initially considered a female sex hormone, estrogen is now recognized as a systemic substance that affects every organ system and appears to be important for both men’s and women’s health.1-4 At puberty, elevated circulating estrogen levels transform girls into young women and shape their feminine fig-ures. In boys, estrogen is important in the closure of the epiphyseal plates to arrest postpubertal growth and support bone health throughout life. It also may have beneficial actions on the male cardiovascular system.2
As a systemic hormone, estrogen is important in women for the health of the skeleton, the heart, the integuments, and the brain.1,3 Women who suffer the loss of estrogen through surgery, illness, or early menopause often are advised to consider estrogen therapy to protect these organs from premature failure.
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