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breast cancer in very high-risk groups, ie, those with genetic predispositions Side effects of tamoxifen include an agedependent small increase in the risk of endometrial cancer (including sarcoma of the uterus), deep venous thrombosis, and pulmonary embolism These side effects are seen primarily in women over age 50 years The use of tamoxifen for primary prevention of cancer is controversial because of its known secondary effects, mainly the increase in endometrial cancer This risk is small when compared with the incidence of breast cancer in younger women on placebo in the trial Even if the incidences of endometrial cancer and breast cancer are considered together, there was still a 30% reduction in the risk of cancer in the women receiving tamoxifen Raloxifene is a novel SERM with estrogenic effects on bone and lipids and estrogen antagonist effects on the breast and uterus that has also been studied as a chemopreventive agent Two different doses of raloxifene or placebo were administered to 7700 postmenopausal women in the Multiple Outcomes of Raloxifene Evaluation (MORE) trial to test the hypothesis that raloxifene would reduce the risk of bone fractures After 25 years, a 70% relative reduction in the risk of breast cancer was found in the women taking raloxifene compared with the women taking placebo The Study of Tamoxifen and Raloxifene (STAR) was designed to determine whether raloxifene is as effective as tamoxifen at reducing the risk for breast cancer The trial opened in 1999 and closed to enrollment in 2004 after randomizing 19,000 American and Canadian postmenopausal women who were are at increased risk for breast cancer to either daily tamoxifen (20 mg/d) or raloxifene (60 mg/d) for 5 years Raloxifene was as effective as tamoxifen at reducing the risk of invasive breast cancers but not as effective at reducing new cases of in situ cancers Raloxifene was associated with fewer cases of endometrial cancer, thromboembolic event, and cataracts Raloxifene is now an alternative for the prevention of breast cancer in moderately high-risk postmenopausal women It should not be combined with tamoxifen, or used for the treatment of osteoporosis in women receiving hormonal therapy for breast cancer Other studies on breast cancer can be found at the NCI clinical trials Web site (wwwcancergov/clinical_trials) or by calling 800-4-CANCER At the prevention Web site (www breastcancerpreventionorg), a link is provided to permit calculation of the risk for an individual patient of developing breast cancer A new class of hormonal agents is being tested in clinical trials for primary prevention of breast cancer The aromatase inhibitors block the peripheral conversion of androstenedione and testosterone to estradiol in postmenopausal women and are highly effective as treatment of postmenopausal women with early- and late-stage breast cancer The aromatase inhibitors block the tissue production of estrogen that plays an important role in the development of postmenopausal breast cancer Data from a number of adjuvant hormonal therapy trials indicate that the aromatase inhibitors have a potent effect in the prevention of new breast cancers in women with previously diagnosed invasive cancer These agents do not cause either an increased risk of thrombosis or endometrial cancer, making them possibly more suitable.

agents for prevention in a healthy population The primary side effects include accelerated loss of bone mineral density, joint and muscle aches, and an altered lipid profile Ongoing trials targeting women at high risk for developing breast cancer, postmenopausal women with BRCA mutations, and women with a diagnosis of ductal carcinoma in situ are comparing the different aromatase inhibitors with each other, with tamoxifen, or with placebo Further follow-up and results from these trials will be needed to understand the impact of aromatase inhibitors in the area of prevention as well as their long-term side effects

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Following is a list of user exits and function modules used in Sales and Distribution processing To save space I have not documented all of them However, there is adequate documentation within the exit For example, to investigate: Program MV45AFZZ - USEREXIT_DELETE_DOCUMENT enter transaction code [SE38] Click the Source Code radio button, then click the Display button as seen in Figure 11-3 Page down until you see FORM USEREXIT_DELETE_DOCUMENT, as seen in Figure 11-4 You may read the comments in the code which explain the user exit s usage From here you need basic ABAP navigation skills to see the source code of the form, which is not in the scope of this book

Isoflavones are found in a variety of natural substances, including soy Laboratory studies have shown that isoflavones such as those found in soy inhibit the growth of breast cancer cell lines; however, epidemiologic studies evaluating consumption of isoflavone-containing foods have shown inconsistent results The Japan Public Health Center-based Prospective Study on Cancer and Cardiovascular Diseases enrolled almost 22,000 Japanese women between the ages of 40 and 59 years The risk of breast cancer in women who consumed three or more bowls of miso soup daily containing over 25 mg of genistein was 50% less than the risk in women who consumed less than one bowl (about 7 mg genistein), and this effect was greatest among postmenopausal women Interestingly, consumption of other foods containing soy soybeans, tofus, etc was not associated with a reduction in risk of breast cancer Further trials, including trials in white women who have a higher baseline risk of breast cancer, are required to confirm this interesting observation

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