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In Reply: In our Editorial, we focused on breast cancer chemoprevention as the basis of therapy. Dr Goldstein illustrates that there are individual cases in which raloxifene is a superior choice of therapy. Similarly, there are cases in which tamoxifen may be a better choice. Patient preference and issues related to cost or confidence in the long-term sequelae of tamoxifen therapy may influence a patient to choose, with her physician, tamoxifen over raloxifene.

We agree that more aggressive bone chemoprevention with raloxifene may have secondary benefits of breast cancer chemoprevention. The STAR trial results in and of themselves do not point to a clear choice between tamoxifen and raloxifene across the board. However, we can be reasonably certain that either one is better than nothing.

Financial Disclosures: Dr Cella reports that he serves on the steering committee for the AstraZeneca ATAC trial but receives no compensation for this. Dr Gradishar . . . [Full Text of this Article]

William J. Gradishar, MD
w-gradishar@northwestern.edu

David Cella, PhD
Division of Hematology/Oncology
Northwestern University Feinberg School of Medicine
Chicago, Ill

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