The Achilles Heel of Chemoprevention: Bone Health?

Although chemoprevention with tamoxifen or raloxifene has proven to be an effective strategy for reducing risk for breast cancer, the uptake of this strategy by women at threshold risk for breast cancer has been disappointingly low. Adverse effects — including blood clots and endometrial carcinoma — that are attributable to tamoxifen and, less so, to raloxifene partly explain the reluctance to recommend or accept these drugs for chemoprevention.

An alternate agent, the steroidal aromatase inhibitor (AI) exemestane, was shown in the recent MAP.3 trial (JW Gen Med Jun 23 2011) to reduce risk for breast cancer more effectively than placebo in postmenopausal women (hazard ratio, 0.35; P=0.002) without increasing risk for cardiovascular events. H…