Tamoxifen and breast cancer--from palliation to prevention

Tamoxifen, a synthetic antiestrogen, has been used in the treatment of all stages of breast cancer. The National Surgical Adjuvant Breast and Bowel Project (NSABP) is now in the process of evaluating the role of tamoxifen in the prevention of breast cancer (NSABP P-1 trial). Beneficial effects of tamoxifen in reducing coronary artery disease and preventing bone fractures in postmenopausal women will also be examined. Adjuvant therapy trials conducted during the 1980s provided extensive data on the biologic and possibly toxic effects of tamoxifen. These trials laid the groundwork to support the benefits and risks of the present preventional trial. The NSABP P-1 trial population of 16,000 participants will consist of women > or = 60 years of age and women 35-39 years old who are at increased risk for developing breast cancer. Nursing will play an important role in educating the public and counseling possible trial participants. Nurses monitoring the progress of this trial may witness the use of tamoxifen therapy come full cycle--from a palliative agent used in advanced breast cancer to a therapeutic agent that prevents the development of breast cancer.