To the Editor: In his Clinical Crossroads article, Dr Come1 outlines adjuvant therapy options for postmenopausal breast cancer patients and raises safety concerns for aromatase inhibitors regarding fractures and lipid profile change. However, no protocol-defined screening or therapy related to bone health was used in any aromatase inhibitor trial, and guidelines are now available to inform management of this issue.2
The influence of aromatase inhibitors and tamoxifen on lipids has been recently reviewed.3 While tamoxifen reduces total and low-density lipoprotein (LDL) cholesterol levels, a potentially unfavorable increase in triglyceride levels is also seen. In contrast, aromatase inhibitors do not influence total or LDL cholesterol levels, but they do increase high-density lipoprotein (HDL) cholesterol levels in some studies and consistently decrease triglyceride levels.3
I agree that additional follow-up of existing trials will ultimately determine the aromatase inhibitor risk/benefit ratio. However, currently available information can mitigate some concerns regarding adjuvant aromatase inhibitor use.
Financial Disclosures: Dr Chlebowski reported being a consultant for Astra-Zeneca, Novartis, and Pfizer.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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