The effect of SERMs on the endometrium.
Tamoxifen, the first clinically available SERM, was developed in 1966 and approved by the FDA (United States Food and Drug Administration) in 1978. It is the most prescribed antineoplastic drug in the world, with approximately 10 million women-use-years of experience. Tamoxifen has proved efficacious in all settings of breast cancer. However, in the mid-to-late 1980s, a series of letters to the editor and case reports announced an association between tamoxifen therapy in women with breast cancer and the development of endometrial carcinoma. Subsequently, in 1998, the observation of a significant 49% reduction in invasive breast cancer relative to placebo in a cohort of women at increased risk for the disease resulted in the early stopping of the National Surgical Adjuvant Breast and Bowel Project's (NSABP) P-1: Breast Cancer Prevention Trial (BCPT). Importantly, this was the first time that information became available about the effects of tamoxifen in healthy women, that is, women who did not already have breast cancer. In this healthy population, the relative risk of developing endometrial carcinoma in the tamoxifen arm was 2.54, although when stratified by age, in women over 50, the risk grew to 4.01. Thus, the risk appears to be confined to women over 50 because, in contrast, in women under 50 there was no statistically significant increase in the risk of endometrial carcinoma.
Goldstein
S R
SR
Department of Obstetrics and Gynecology, New York University School of Medicine, New York 10016, USA. Steven.Goldstein@Med.Nyu.Edu
D001943:Breast Neoplasms / Q000188:drug therapy / Q000473:pathology; D016889:Endometrial Neoplasms / Q000139:chemically induced*; D004717:Endometrium / Q000187:drug effects*; D005260:Female; D006801:Humans; D009361:Neoplasm Invasiveness / Q000517:prevention & control; D020849:Raloxifene Hydrochloride / Q000627:therapeutic use; D020845:Selective Estrogen Receptor Modulators / Q000494:pharmacology*; D013629:Tamoxifen / Q000009:adverse effects / Q000627:therapeutic use*
D020845:Selective Estrogen Receptor Modulators; D013629:Tamoxifen; D020849:Raloxifene Hydrochloride