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Old Breast Cancer Drug Still No. 1

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In addition, some women who have never had breast cancer before but are at a high risk for breast cancer take tamoxifen as a way to lower their risk. "So it is pretty much a no-brainer that if one of these women develops breast cancer, she is obviously not a good candidate for more tamoxifen, so an aromatase inhibitor would be a better choice."

And not all of the oncologists at the meeting agree with the new guidelines. Paul Goss, MD, director of the Breast Cancer Prevention Program at Princess Margaret Hospital in Toronto and professor of medicine at the University of Toronto, Ontario, said he believes "these recommendations are too cautious." He points out that for more than 15 years there has been ample evidence that limiting estrogen production is an effective way to prevent breast cancer.

For doctors and patients who decide to follow the tamoxifen recommendation, Kathy Albain, MD, professor of medicine at Loyola University Cardinal Bernardin Cancer Center in Chicago, says that there is a right and wrong way to take tamoxifen. She says that results of a study of 1,477 postmenopausal women with breast cancer suggest that taking tamoxifen at the same time as chemotherapy "reduces tamoxifen's benefit by half."

To get the maximum benefit, tamoxifen should be initiated after chemotherapy is completed, usually about six months after surgery.

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