Despite a declining incidence, breast cancer remains the most common cancer among women in the United States.1 More than two-thirds of all patients with breast cancer present with tumors that express estrogen receptors, progesterone receptors, or both, and the modulation of estrogen receptor signaling has been one of the most successful strategies for these patients. In recent years, the most commonly used forms of endocrine therapy have included the competitive inhibition of the estrogen receptors with an antiestrogen (selective estrogen receptor modulators [SERMs], eg, tamoxifen, or selective estrogen–receptor down-regulators, [SERDs], eg, fulvestrant) and the decrease in estrogen production from precursor steroid hormones using an aromatase inhibitor.
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