Chemotherapy and Tamoxifen for Breast Cancer

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To the Editor: Fisher et al. compared the use of melphalan (lphenylalanine mustard) plus fluorouracil with the use of the antiestrogen tamoxifen plus melphalan and fluorouracil in a large trial of adjuvant therapy in 1863 women with primary breast carcinoma and positive axillary nodes.1 Older women benefited from the addition of tamoxifen, whereas those below 49 years old had no substantial prolongation of disease-free survival. This finding raises two important biologic questions: How effective an antiestrogen is tamoxifen at the dose used (10 mg twice a day) in premenopausal patients? Does melphalan plus fluorouracil cause a "chemical oophorectomy" in premenopausal . . .