SERMs May Be Healthier Choice Than HRT 

'Designer estrogens' do not increase breast cancer risk 

Physicians and women are showing renewed interest in medications known as selective estrogen receptor modulators, or SERMS. 

That is especially true since conventional hormone replacement therapy has been linked to unacceptable health risks.

SERMS, also called designer estrogens, offer an alternative to HRT. And they can eliminate one of the side effects of HRT, an increased risk of breast cancer, according to an article on the medications in the January 2003 issue of Cancer.

The authors, from the University of Athens and the University of Patras in Greece, spell out the advantages of SERMS over HRT. One advantage is the ability to individualize treatments, depending on whether a woman needs to build bone, reduce breast cancer risk, or other goals.

How SERMs Work

SERMS block the actions of estrogen in breast tissue and in certain other tissues by filling up the estrogen receptor cells. While the SERM medication fills in the receptor, it does not send messages to the cell to grow and divide, thus reducing cancer risk. However, the SERM medicines do send estrogen-like signals when they fill up receptors in bone cells, thus helping to slow or prevent osteoporosis, the researchers say.

Among the common SERMS are tamoxifen (Nolvadex), toremifene (Fareston), and raloxifene (Evista).

SERMS may be preferred over conventional HRT, the authors write, because they mitigate the breast cancer risk but maintain many of the therapeutic benefits of estrogen replacement therapy.

Portion of Women's Health Initiative Halted

Earlier this year, a portion of the massive Women's Health Initiative, a study in which women were given estrogen and progestin, was halted when the overall health risks were found to exceed the benefits. Specifically, for every 10,000 women taking combined HRT for one year, there were seven more coronary heart disease events, eight more strokes, eight more cases of lung embolism, and eight more invasive breast cancers than in women taking a placebo. Those on HRT had six fewer colon cancers and five fewer hip fractures. The estrogen-only arm of the trial is continuing.

SERMs Offer Promising Alternative to Convention HRT

SERMs are a promising alternative to conventional HRT, the authors conclude. Taking a multidisciplinary approach will help physicians and women individualize therapy, depending on their needs and risks.

"This ultimately should provide women and their physicians with the ability to make safe and confident selections from a repertoire of medications that promise to expand the life span and improve the quality of life for women after menopause," they conclude.

Another expert, Dr. Victor G. Vogel, a professor of medicine and epidemiology at the University of Pittsburgh who studies SERMS, applauds the article and says attention to SERMs is past due. The medications, he says, "can lower breast cancer risk, sometimes by 40 or 50 percent." And they can reduce the risk of fractures and come without some of the other side effects found with combination HRT use. SERMs can also lower cholesterol, Vogel says.

"In light of the new data on hormone therapy," Vogel says, "physicians and women are wise to rethink their medication strategy for health-related problems that occur later in life, such as osteoporosis. What these Greek authors are saying is, there are some options here," Vogel says.

Like other experts, Vogel says women can take HRT on a short-term basis for relief of menopausal symptoms such as hot flashes. The SERMs, as Vogel and the authors of the paper point out, do not help hot flushes and can actually increase them.

"I am a somewhat biased observer, because I have written on the topic," says Vogel. He also served on the data and safety monitoring board for the Women's Health Initiative. "I was one of those folks who said, "We have to halt this trial."

Always consult your physician for more information.

Online Resources

American Cancer Society

American College of Obstetricians and Gynecologists

CA: A Cancer Journal for Clinicians