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In Reply: Dr Pritchard is correct: a person with hormone receptor–positive breast cancer would likely receive antihormone therapy for recurrent metastatic disease and would remain on a given agent if tolerated until the disease worsened or recurred. For Ms H, that would have meant starting tamoxifen or an aromatase inhibitor at the first recurrence and then switching to the other when disease worsened. Although the authors of the article were provided with detailed information on Ms H's radiation and surgical therapies, we do not know whether she received antihormone therapies.

Financial Disclosures: Dr Abrahm reported that she is a member of the speakers' bureau for Merck and Purdue Pharma and is on the advisory board for Endo Pharmaceuticals and Wyeth.

Janet L. Abrahm, MD
jabrahm@partners.org
Division of Psychosocial Oncology and Palliative Care
Dana-Farber Cancer Institute
Boston, Massachusetts

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2008;299(23):2745.

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