Is there a role for raloxifene and tamoxifen for the prevention of breast cancer?

Breast cancer is the leading oncologic disease in women in the world and is the second leading cause of death in Western women. A major advance in breast cancer chemoprevention in healthy high risk women occurred with the pioneering studies of the Selective Estrogen Receptor Modulators (SERMs) tamoxifen and raloxifene. Tamoxifen, the first targeted therapy for the treatment of breast cancer approved by the Food and Drug Administration (FDA), was subsequently successful in significantly reducing the incidence of breast cancer in high risk women. Nevertheless, tamoxifen has some adverse effects in the uterus. Raloxifene, that is also FDA approved for breast cancer prevention in high risk postmenopausal women and separately for osteoporosis, has a better safety profile than tamoxifen. In this chapter we will describe the history, the current role and deficiencies of tamoxifen and raloxifene in the prevention of breast cancer. The potential of other SERMs and new approaches to hormone replacement to improve women’s health but to reduce the risk of breast cancer are illustrated.