To the Editor: Dr Vogel and colleagues1 reported the results of the Study of Tamoxifen and Raloxifene (STAR) P-2 trial. I was disappointed that in the accompanying Editorial, Drs Gradishar and Cella2 did not comment on the role of the effects of raloxifene on the breast when choosing an agent to treat a patient with osteoporosis or osteopenia who has breast cancer risk factors. The MORE3 and CORE4 trials, while not performed on a group at high risk for breast cancer, showed a significant reduction in new-onset breast cancer. This may not be widely known because raloxifene is not approved for any breast indication.
Gradishar and Cella state that “decision making for an individual patient who is considering a preventive agent to reduce the risk of breast cancer must also take into account other health issues that may very well outweigh the risk of developing breast cancer.” I would further say that decision making for an individual patient who is considering a preventive agent to reduce the risk of fragility fracture must also take into account her risk of developing breast cancer. Bisphosphonates have no beneficial effect on the breast. Raloxifene may be a superior treatment choice for a woman with osteopenia and breast cancer risk factors. Breast cancer chemoprevention data should factor into bone chemoprevention decisions.
Financial Disclosures: Dr Goldstein reports that he has served on advisory boards for Merck, Pfizer, GlaxoSmithKline, Eli Lilly, and Procter & Gamble.
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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