Bone fractures among postmenopausal patients with endocrine-responsive early breast cancer treated with 5 years of letrozole or tamoxifen in the BIG 1-98 trial
Identifieur interne : 000127 ( Istex/Curation ); précédent : 000126; suivant : 000128Bone fractures among postmenopausal patients with endocrine-responsive early breast cancer treated with 5 years of letrozole or tamoxifen in the BIG 1-98 trial
Auteurs : M. Rabaglio [Suisse] ; Z. Sun [États-Unis] ; K. N. Price [États-Unis] ; M. Castiglione-Gertsch [Suisse] ; H. Hawle [Suisse] ; B. Thürlimann ; H. Mouridsen [Danemark] ; M. Campone [France] ; J. F. Forbes [Australie] ; R. J. Paridaens [Belgique] ; M. Colleoni [Italie] ; T. Pienkowski [Pologne] ; J.-M. Nogaret [Belgique] ; I. Láng [Hongrie] ; I. Smith [Royaume-Uni] ; R. D. Gelber [États-Unis] ; A. Goldhirsch [Italie, Suisse] ; A. S. Coates [Australie]Source :
- Annals of Oncology [ 0923-7534 ] ; 2009-05-27.
Abstract
Background: To compare the incidence and timing of bone fractures in postmenopausal women treated with 5 years of adjuvant tamoxifen or letrozole for endocrine-responsive early breast cancer in the Breast International Group (BIG) 1-98 trial. Methods: We evaluated 4895 patients allocated to 5 years of letrozole or tamoxifen in the BIG 1-98 trial who received at least some study medication (median follow-up 60.3 months). Bone fracture information (grade, cause, site) was collected every 6 months during trial treatment. Results: The incidence of bone fractures was higher among patients treated with letrozole [228 of 2448 women (9.3%)] versus tamoxifen [160 of 2447 women (6.5%)]. The wrist was the most common site of fracture in both treatment groups. Statistically significant risk factors for bone fractures during treatment included age, smoking history, osteoporosis at baseline, previous bone fracture, and previous hormone replacement therapy. Conclusions: Consistent with other trials comparing aromatase inhibitors to tamoxifen, letrozole was associated with an increase in bone fractures. Benefits of superior disease control associated with letrozole and lower incidence of fracture with tamoxifen should be considered with the risk profile for individual patients.
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DOI: 10.1093/annonc/mdp033
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B. Thürlimann<affiliation><mods:affiliation>Senology Center of Eastern Switzerland and Swiss Group for Clinical Cancer Research (SAKK), Kantonsspital, St Gallen, Switzerland, Swiss Group for Clinical Cancer Research (SAKK)</mods:affiliation><wicri:noCountry code="subField">(SAKK)</wicri:noCountry></affiliation>Le document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title>Bone fractures among postmenopausal patients with endocrine-responsive early breast cancer treated with 5 years of letrozole or tamoxifen in the BIG 1-98 trial</title><author><name sortKey="Rabaglio, M" sort="Rabaglio, M" uniqKey="Rabaglio M" first="M." last="Rabaglio">M. Rabaglio</name><affiliation wicri:level="1"><mods:affiliation>IBCSG Coordinating Center and Inselspital, Bern, Switzerland</mods:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>IBCSG Coordinating Center and Inselspital, Bern</wicri:regionArea></affiliation><affiliation><mods:affiliation>*Correspondence to: M. Rabaglio, International Breast Cancer Study Group Coordinating Center, Effingerstrasse 40, CH-3008 Bern, Switzerland; Tel: +41 31 389 93 91; Fax: +41 31 389 93 92;</mods:affiliation><wicri:noCountry code="subField">92;</wicri:noCountry></affiliation></author><author><name sortKey="Sun, Z" sort="Sun, Z" uniqKey="Sun Z" first="Z." last="Sun">Z. Sun</name><affiliation wicri:level="2"><mods:affiliation>IBCSG Statistical Center, Dana-Farber Cancer Institute, Boston, MA</mods:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Massachusetts</region></placeName><wicri:cityArea>IBCSG Statistical Center, Dana-Farber Cancer Institute, Boston</wicri:cityArea></affiliation></author><author><name sortKey="Price, K N" sort="Price, K N" uniqKey="Price K" first="K. N." last="Price">K. N. 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Castiglione-Gertsch</name><affiliation wicri:level="3"><mods:affiliation>IBCSG Coordinating Center, Bern</mods:affiliation><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName><wicri:orgArea>IBCSG Coordinating Center</wicri:orgArea></affiliation></author><author><name sortKey="Hawle, H" sort="Hawle, H" uniqKey="Hawle H" first="H." last="Hawle">H. Hawle</name><affiliation wicri:level="3"><mods:affiliation>IBCSG Coordinating Center, Bern</mods:affiliation><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName><wicri:orgArea>IBCSG Coordinating Center</wicri:orgArea></affiliation></author><author><name sortKey="Thurlimann, B" sort="Thurlimann, B" uniqKey="Thurlimann B" first="B." last="Thürlimann">B. Thürlimann</name><affiliation><mods:affiliation>Senology Center of Eastern Switzerland and Swiss Group for Clinical Cancer Research (SAKK), Kantonsspital, St Gallen, Switzerland, Swiss Group for Clinical Cancer Research (SAKK)</mods:affiliation><wicri:noCountry code="subField">(SAKK)</wicri:noCountry></affiliation></author><author><name sortKey="Mouridsen, H" sort="Mouridsen, H" uniqKey="Mouridsen H" first="H." last="Mouridsen">H. Mouridsen</name><affiliation wicri:level="1"><mods:affiliation>Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark</mods:affiliation><country xml:lang="fr">Danemark</country><wicri:regionArea>Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen</wicri:regionArea></affiliation></author><author><name sortKey="Campone, M" sort="Campone, M" uniqKey="Campone M" first="M." last="Campone">M. Campone</name><affiliation wicri:level="1"><mods:affiliation>Institut du Cancer Nantes Atlantique, CLCC René Gauducheau, Saint Herblain, Fédération Nationale des Centres de Lutte Contre le Cancer, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Institut du Cancer Nantes Atlantique, CLCC René Gauducheau, Saint Herblain, Fédération Nationale des Centres de Lutte Contre le Cancer</wicri:regionArea></affiliation></author><author><name sortKey="Forbes, J F" sort="Forbes, J F" uniqKey="Forbes J" first="J. F." last="Forbes">J. F. Forbes</name><affiliation wicri:level="1"><mods:affiliation>Australian New Zealand Breast Cancer Trials Group, University of Newcastle, Calvary Mater Newcastle, Newcastle, New South Wales, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Australian New Zealand Breast Cancer Trials Group, University of Newcastle, Calvary Mater Newcastle, Newcastle, New South Wales</wicri:regionArea></affiliation></author><author><name sortKey="Paridaens, R J" sort="Paridaens, R J" uniqKey="Paridaens R" first="R. J." last="Paridaens">R. J. Paridaens</name><affiliation wicri:level="1"><mods:affiliation>Department of Medical Oncology, University Hospital Gasthuisberg, Catholic University of Leuven, Leuven, Belgium</mods:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Medical Oncology, University Hospital Gasthuisberg, Catholic University of Leuven, Leuven</wicri:regionArea></affiliation></author><author><name sortKey="Colleoni, M" sort="Colleoni, M" uniqKey="Colleoni M" first="M." last="Colleoni">M. Colleoni</name><affiliation wicri:level="1"><mods:affiliation>Research Unit in Medical Senology, Department of Medicine, European Institute of Oncology, Milan, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Research Unit in Medical Senology, Department of Medicine, European Institute of Oncology, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Pienkowski, T" sort="Pienkowski, T" uniqKey="Pienkowski T" first="T." last="Pienkowski">T. Pienkowski</name><affiliation wicri:level="1"><mods:affiliation>Cancer Center Maria Sklodowska-Curie Memorial Institute of Oncology, Warsaw, Poland</mods:affiliation><country xml:lang="fr">Pologne</country><wicri:regionArea>Cancer Center Maria Sklodowska-Curie Memorial Institute of Oncology, Warsaw</wicri:regionArea></affiliation></author><author><name sortKey="Nogaret, J M" sort="Nogaret, J M" uniqKey="Nogaret J" first="J.-M." last="Nogaret">J.-M. Nogaret</name><affiliation wicri:level="1"><mods:affiliation>Department of Mammary and Pelvic Surgery, Jules Bordet Institute; Brussels, Belgium</mods:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Mammary and Pelvic Surgery, Jules Bordet Institute; Brussels</wicri:regionArea></affiliation></author><author><name sortKey="Lang, I" sort="Lang, I" uniqKey="Lang I" first="I." last="Láng">I. Láng</name><affiliation wicri:level="1"><mods:affiliation>Department of Medical Oncology, National Institute of Oncology, Budapest, Hungary</mods:affiliation><country xml:lang="fr">Hongrie</country><wicri:regionArea>Department of Medical Oncology, National Institute of Oncology, Budapest</wicri:regionArea></affiliation></author><author><name sortKey="Smith, I" sort="Smith, I" uniqKey="Smith I" first="I." last="Smith">I. Smith</name><affiliation wicri:level="1"><mods:affiliation>Breast Unit, The Royal Marsden Hospital, London, UK</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Breast Unit, The Royal Marsden Hospital, London</wicri:regionArea></affiliation></author><author><name sortKey="Gelber, R D" sort="Gelber, R D" uniqKey="Gelber R" first="R. D." last="Gelber">R. D. Gelber</name><affiliation wicri:level="1"><mods:affiliation>IBCSG Statistical Center, Dana-Farber Cancer Institute, Harvard School of Public Health and Harvard Medical School, Boston, MA, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>IBCSG Statistical Center, Dana-Farber Cancer Institute, Harvard School of Public Health and Harvard Medical School, Boston, MA</wicri:regionArea></affiliation></author><author><name sortKey="Goldhirsch, A" sort="Goldhirsch, A" uniqKey="Goldhirsch A" first="A." last="Goldhirsch">A. Goldhirsch</name><affiliation wicri:level="1"><mods:affiliation>Department of Medicine, European Institute of Oncology, Milan, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Medicine, European Institute of Oncology, Milan</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Oncology Institute of Southern Switzerland, Bellinzona, Switzerland</mods:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Oncology Institute of Southern Switzerland, Bellinzona</wicri:regionArea></affiliation></author><author><name sortKey="Coates, A S" sort="Coates, A S" uniqKey="Coates A" first="A. S." last="Coates">A. S. Coates</name><affiliation wicri:level="1"><mods:affiliation>International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:06D9E0FD9E0C9EAD991BC6E43B3D245723514AE4</idno><date when="2009" year="2009">2009</date><idno type="doi">10.1093/annonc/mdp033</idno><idno type="url">https://api.istex.fr/document/06D9E0FD9E0C9EAD991BC6E43B3D245723514AE4/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">000127</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000127</idno><idno type="wicri:Area/Istex/Curation">000127</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Bone fractures among postmenopausal patients with endocrine-responsive early breast cancer treated with 5 years of letrozole or tamoxifen in the BIG 1-98 trial</title><author><name sortKey="Rabaglio, M" sort="Rabaglio, M" uniqKey="Rabaglio M" first="M." last="Rabaglio">M. Rabaglio</name><affiliation wicri:level="1"><mods:affiliation>IBCSG Coordinating Center and Inselspital, Bern, Switzerland</mods:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>IBCSG Coordinating Center and Inselspital, Bern</wicri:regionArea></affiliation><affiliation><mods:affiliation>*Correspondence to: M. Rabaglio, International Breast Cancer Study Group Coordinating Center, Effingerstrasse 40, CH-3008 Bern, Switzerland; Tel: +41 31 389 93 91; Fax: +41 31 389 93 92;</mods:affiliation></affiliation></author><author><name sortKey="Sun, Z" sort="Sun, Z" uniqKey="Sun Z" first="Z." last="Sun">Z. Sun</name><affiliation wicri:level="2"><mods:affiliation>IBCSG Statistical Center, Dana-Farber Cancer Institute, Boston, MA</mods:affiliation><country xml:lang="fr">États-Unis</country><placeName><region type="state">Massachusetts</region></placeName><wicri:cityArea>IBCSG Statistical Center, Dana-Farber Cancer Institute, Boston</wicri:cityArea></affiliation></author><author><name sortKey="Price, K N" sort="Price, K N" uniqKey="Price K" first="K. N." last="Price">K. N. Price</name><affiliation wicri:level="1"><mods:affiliation>IBCSG Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>IBCSG Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA</wicri:regionArea></affiliation><affiliation><mods:affiliation>*Correspondence to: M. Rabaglio, International Breast Cancer Study Group Coordinating Center, Effingerstrasse 40, CH-3008 Bern, Switzerland; Tel: +41 31 389 93 91; Fax: +41 31 389 93 92; E-mail: manuela.rabaglio@ibcsg.org.</mods:affiliation></affiliation></author><author><name sortKey="Castiglione Gertsch, M" sort="Castiglione Gertsch, M" uniqKey="Castiglione Gertsch M" first="M." last="Castiglione-Gertsch">M. Castiglione-Gertsch</name><affiliation wicri:level="3"><mods:affiliation>IBCSG Coordinating Center, Bern</mods:affiliation><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName><wicri:orgArea>IBCSG Coordinating Center</wicri:orgArea></affiliation></author><author><name sortKey="Hawle, H" sort="Hawle, H" uniqKey="Hawle H" first="H." last="Hawle">H. Hawle</name><affiliation wicri:level="3"><mods:affiliation>IBCSG Coordinating Center, Bern</mods:affiliation><country>Suisse</country><placeName><settlement type="city">Berne</settlement><region type="région" nuts="3">Canton de Berne</region></placeName><wicri:orgArea>IBCSG Coordinating Center</wicri:orgArea></affiliation></author><author><name sortKey="Thurlimann, B" sort="Thurlimann, B" uniqKey="Thurlimann B" first="B." last="Thürlimann">B. Thürlimann</name><affiliation><mods:affiliation>Senology Center of Eastern Switzerland and Swiss Group for Clinical Cancer Research (SAKK), Kantonsspital, St Gallen, Switzerland, Swiss Group for Clinical Cancer Research (SAKK)</mods:affiliation><wicri:noCountry code="subField">(SAKK)</wicri:noCountry></affiliation></author><author><name sortKey="Mouridsen, H" sort="Mouridsen, H" uniqKey="Mouridsen H" first="H." last="Mouridsen">H. Mouridsen</name><affiliation wicri:level="1"><mods:affiliation>Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen, Denmark</mods:affiliation><country xml:lang="fr">Danemark</country><wicri:regionArea>Danish Breast Cancer Cooperative Group, Rigshospitalet, Copenhagen</wicri:regionArea></affiliation></author><author><name sortKey="Campone, M" sort="Campone, M" uniqKey="Campone M" first="M." last="Campone">M. Campone</name><affiliation wicri:level="1"><mods:affiliation>Institut du Cancer Nantes Atlantique, CLCC René Gauducheau, Saint Herblain, Fédération Nationale des Centres de Lutte Contre le Cancer, France</mods:affiliation><country xml:lang="fr">France</country><wicri:regionArea>Institut du Cancer Nantes Atlantique, CLCC René Gauducheau, Saint Herblain, Fédération Nationale des Centres de Lutte Contre le Cancer</wicri:regionArea></affiliation></author><author><name sortKey="Forbes, J F" sort="Forbes, J F" uniqKey="Forbes J" first="J. F." last="Forbes">J. F. Forbes</name><affiliation wicri:level="1"><mods:affiliation>Australian New Zealand Breast Cancer Trials Group, University of Newcastle, Calvary Mater Newcastle, Newcastle, New South Wales, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>Australian New Zealand Breast Cancer Trials Group, University of Newcastle, Calvary Mater Newcastle, Newcastle, New South Wales</wicri:regionArea></affiliation></author><author><name sortKey="Paridaens, R J" sort="Paridaens, R J" uniqKey="Paridaens R" first="R. J." last="Paridaens">R. J. Paridaens</name><affiliation wicri:level="1"><mods:affiliation>Department of Medical Oncology, University Hospital Gasthuisberg, Catholic University of Leuven, Leuven, Belgium</mods:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Medical Oncology, University Hospital Gasthuisberg, Catholic University of Leuven, Leuven</wicri:regionArea></affiliation></author><author><name sortKey="Colleoni, M" sort="Colleoni, M" uniqKey="Colleoni M" first="M." last="Colleoni">M. Colleoni</name><affiliation wicri:level="1"><mods:affiliation>Research Unit in Medical Senology, Department of Medicine, European Institute of Oncology, Milan, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Research Unit in Medical Senology, Department of Medicine, European Institute of Oncology, Milan</wicri:regionArea></affiliation></author><author><name sortKey="Pienkowski, T" sort="Pienkowski, T" uniqKey="Pienkowski T" first="T." last="Pienkowski">T. Pienkowski</name><affiliation wicri:level="1"><mods:affiliation>Cancer Center Maria Sklodowska-Curie Memorial Institute of Oncology, Warsaw, Poland</mods:affiliation><country xml:lang="fr">Pologne</country><wicri:regionArea>Cancer Center Maria Sklodowska-Curie Memorial Institute of Oncology, Warsaw</wicri:regionArea></affiliation></author><author><name sortKey="Nogaret, J M" sort="Nogaret, J M" uniqKey="Nogaret J" first="J.-M." last="Nogaret">J.-M. Nogaret</name><affiliation wicri:level="1"><mods:affiliation>Department of Mammary and Pelvic Surgery, Jules Bordet Institute; Brussels, Belgium</mods:affiliation><country xml:lang="fr">Belgique</country><wicri:regionArea>Department of Mammary and Pelvic Surgery, Jules Bordet Institute; Brussels</wicri:regionArea></affiliation></author><author><name sortKey="Lang, I" sort="Lang, I" uniqKey="Lang I" first="I." last="Láng">I. Láng</name><affiliation wicri:level="1"><mods:affiliation>Department of Medical Oncology, National Institute of Oncology, Budapest, Hungary</mods:affiliation><country xml:lang="fr">Hongrie</country><wicri:regionArea>Department of Medical Oncology, National Institute of Oncology, Budapest</wicri:regionArea></affiliation></author><author><name sortKey="Smith, I" sort="Smith, I" uniqKey="Smith I" first="I." last="Smith">I. Smith</name><affiliation wicri:level="1"><mods:affiliation>Breast Unit, The Royal Marsden Hospital, London, UK</mods:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Breast Unit, The Royal Marsden Hospital, London</wicri:regionArea></affiliation></author><author><name sortKey="Gelber, R D" sort="Gelber, R D" uniqKey="Gelber R" first="R. D." last="Gelber">R. D. Gelber</name><affiliation wicri:level="1"><mods:affiliation>IBCSG Statistical Center, Dana-Farber Cancer Institute, Harvard School of Public Health and Harvard Medical School, Boston, MA, USA</mods:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>IBCSG Statistical Center, Dana-Farber Cancer Institute, Harvard School of Public Health and Harvard Medical School, Boston, MA</wicri:regionArea></affiliation></author><author><name sortKey="Goldhirsch, A" sort="Goldhirsch, A" uniqKey="Goldhirsch A" first="A." last="Goldhirsch">A. Goldhirsch</name><affiliation wicri:level="1"><mods:affiliation>Department of Medicine, European Institute of Oncology, Milan, Italy</mods:affiliation><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Medicine, European Institute of Oncology, Milan</wicri:regionArea></affiliation><affiliation wicri:level="1"><mods:affiliation>Oncology Institute of Southern Switzerland, Bellinzona, Switzerland</mods:affiliation><country xml:lang="fr">Suisse</country><wicri:regionArea>Oncology Institute of Southern Switzerland, Bellinzona</wicri:regionArea></affiliation></author><author><name sortKey="Coates, A S" sort="Coates, A S" uniqKey="Coates A" first="A. S." last="Coates">A. S. Coates</name><affiliation wicri:level="1"><mods:affiliation>International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales, Australia</mods:affiliation><country xml:lang="fr">Australie</country><wicri:regionArea>International Breast Cancer Study Group and University of Sydney, Sydney, New South Wales</wicri:regionArea></affiliation></author></analytic><monogr></monogr><series><title level="j">Annals of Oncology</title><idno type="ISSN">0923-7534</idno><idno type="eISSN">1569-8041</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2009-05-27">2009-05-27</date><biblScope unit="volume">20</biblScope><biblScope unit="issue">9</biblScope><biblScope unit="page" from="1489">1489</biblScope><biblScope unit="page" to="1498">1498</biblScope></imprint><idno type="ISSN">0923-7534</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0923-7534</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract">Background: To compare the incidence and timing of bone fractures in postmenopausal women treated with 5 years of adjuvant tamoxifen or letrozole for endocrine-responsive early breast cancer in the Breast International Group (BIG) 1-98 trial. Methods: We evaluated 4895 patients allocated to 5 years of letrozole or tamoxifen in the BIG 1-98 trial who received at least some study medication (median follow-up 60.3 months). Bone fracture information (grade, cause, site) was collected every 6 months during trial treatment. Results: The incidence of bone fractures was higher among patients treated with letrozole [228 of 2448 women (9.3%)] versus tamoxifen [160 of 2447 women (6.5%)]. The wrist was the most common site of fracture in both treatment groups. Statistically significant risk factors for bone fractures during treatment included age, smoking history, osteoporosis at baseline, previous bone fracture, and previous hormone replacement therapy. Conclusions: Consistent with other trials comparing aromatase inhibitors to tamoxifen, letrozole was associated with an increase in bone fractures. Benefits of superior disease control associated with letrozole and lower incidence of fracture with tamoxifen should be considered with the risk profile for individual patients.</div></front></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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