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To the Editor: In his Clinical Crossroads article, Dr Come¹ outlines adjuvant therapy options for postmenopausal breast cancer patients and raises safety concerns for aromatase inhibitors regarding fractures and lipid profile change. However, no protocol-defined screening or therapy related to bone health was used in any aromatase inhibitor trial, and guidelines are now available to inform management of this issue.²

The influence of aromatase inhibitors and tamoxifen on lipids has been recently reviewed.³ While tamoxifen reduces total and low-density lipoprotein (LDL) cholesterol levels, a potentially unfavorable increase in triglyceride levels is also seen. In contrast, aromatase inhibitors do not influence total or LDL cholesterol levels, but they do increase high-density lipoprotein (HDL) cholesterol levels in some studies and consistently decrease triglyceride levels.³

I agree that additional follow-up of existing trials will ultimately determine the aromatase inhibitor risk/benefit ratio. However, currently available information can mitigate some concerns regarding adjuvant aromatase inhibitor . . . [Full Text of this Article]

Rowan T. Chlebowski, MD, PhD
rchlebow@whi.org
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center
Torrance, Calif

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