Correspondance

erable support for a “patients’ bill of ifen-resistant line exposed to References 1. Pritchard KI, Levine M, Walley B, on behalf of rights” that would give patients the for 5 years) “there was no significant the Ad Hoc in Breast Cancer Group. right to sue the insurer as well as the difference between tamoxifen and Raloxifene: handle with care [letter]. CMAJ 2001;165(2):151-3. doctor when performance is inadequate raloxifene, in combination with E2 2. O’Regan RM, Gajdos S, Dardes R, de los Reyes [see page 877]. This must also apply in [] on tumor growth.” Neither A, Bentrem DJ, Jordan VC. Effect of raloxifene Canada because Canadian government the method by which study doses were after tamoxifen on breast and endometrial cancer growth [abstract]. In: Proceedings of the 37th health insurers cannot be less responsi- chosen nor the use of a control group ASCO Annual Meeting; 2001 May 12–15; San ble than their private, for-profit of mice was mentioned in the abstract. Francisco. Abstr. no. 95. 3. Bergman L, Beelen MRL, Gallee MPW, counterparts in the United States. Although we agree with Pritchard and Hollema H, Benraadt J, van Leeuwen FE. Risk The major problem with Canadian colleagues that raloxifene would not be and prognosis of endometrial cancer after tamox- ifen for breast cancer. Lancet 2000; 356:881-7. medical care insurance is the lack of the osteoporosis treatment of choice in 4. Cauley JA, Norton L, Lippman ME, Eckert S, timely access to service, as witnessed by women with tamoxifen-resistant breast Krueger KA, Purdie DW, et al. Continued breast cancer risk reduction in postmenopausal our long waiting lists. A patients’ bill of cancer, it is premature to extrapolate women treated with raloxifene: 4-year results rights in Canada would give patients the results of limited animal-model from the MORE trial. Multiple Outcomes of the right to sue the insurer — the in- studies on the effects of raloxifene on Raloxifene Evaluation. Breast Cancer Res Treat 2001;65:125-34. suring arm of government — for long tamoxifen-dependent breast cancer cell 5. Cohen FJ, Watts S, Shah A, Akers R, Plouffe L delays in treatment. Adoption of this lines to disease-free humans. Jr. Uterine effects of 3-year raloxifene therapy in postmenopausal women younger than age 60. principle would do more to shorten We do not agree with Pritchard and Obstet Gynecol 2000;95:104-10. waiting lists than all the reports from colleagues that “raloxifene is very simi- 6. Grady D, Wenger NK, Herrington D, Khan S, Furberg C, Hunninghake D, et al. Post- government commissions and inquiries, lar to tamoxifen.” There are differences menopausal hormone therapy increases risk for laid end to end. in their respective tissue-specific effects venous thromboembolic disease. The Heart and /progestin Replacement Study. Ann In- This plan would in no way violate that translate into distinct clinical pro- tern Med 2000;132:689-96. the Canada Health Act, nor would it files. For example, while tamoxifen (a 7. Fisher B, Costantino JP, Wickerham DL, Red- mond CK, Kavanah M, Cronin WM, et al. Ta- lead to two-tier medicine or promote triphenylethylene compound) has been moxifen for prevention of breast cancer: report the privatization of medicine. It would shown to have stimulatory and carcino- of the National Surgical Adjuvant Breast and simply compel the government to im- genic effects on the human en- Bowel Project P-1 Study. J Natl Cancer Inst 1998;90:1371-88. plement the act’s principles instead of dometrium,3 raloxifene (a benzothio- paying them lip service. phene) has been proven to have no adverse effects on the endometrium.4,5 Marc Baltzan The risk of venous thromboembolic Corrections Nephrologist events with raloxifene is similar to that Saskatoon, Sask. seen with either tamoxifen or hormone r. Elmira Buxton was predeceased replacement therapy.6,7 D by her husband, Dr. Nigel Bux- We agree that raloxifene is not cur- ton. Incorrect information appeared in Raloxifene and breast cancer rently indicated for breast cancer pre- a recent death notice.1 vention and that it should not be used as a substitute for tamoxifen as adjuvant Reference e wish to acknowledge Kathleen therapy for breast cancer. 1. Deaths. CMAJ 2001;165(4):511. W Pritchard and colleagues for Three large ongoing trials involving bringing to light a number of important over 35 000 women, with reduction of he last line of the final entry in the issues regarding raloxifene and breast breast cancer as the primary endpoint, T third column of Table 1 in a re- cancer.1 will help to further clarify the role of cent commentary by Ross Upshur and In a recent animal study, the effects raloxifene in the prevention of breast colleagues was cut off in error during of raloxifene on several breast cancer cancer. production.1 The entry should read as cell lines (which had been implanted follows: “Unclear whether registrants 2 into athymic mice) were investigated. Joanne Lorraine are aware of the data and their uses.” In the MCF7 (tamoxifen-sensitive) cell Associate Vice President line, no significant growth was noted Clinical Research Reference 1. Upshur REG, Morin B, Goel V. The privacy with either tamoxifen or raloxifene. In Eli Lilly Canada Inc. paradox: laying Orwell’s ghost to rest. CMAJ the MCF7TAMST cell line (a tamox- Toronto, Ont. 2001;165(3):307-9.

888 JAMC • 2 OCT. 2001; 165 (7)