A Model Citizen? Is Tamoxifen More Effective Than Aromatase Inhibitors if We Pick the Right Patients?

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Abstract
After decades of empiricism, the treatment of cancer is widely felt to be entering the era of “targeted” therapy and leading to personalized strategies for individuals with this dreaded disease. Of course, the approach to targeted therapy in oncology is not a new one. Students of breast cancer history point to Sir George Beatson's report in 1896 of the clinical improvement he observed in three young women with locally advanced breast cancer following surgical oophorectomy ( 1 ). Subsequent landmark studies by Jensen, Lippman, and McGuire, among others, demonstrated that what Beatson had actually done was remove a specific growth factor, 17β-estradiol, from its cellular target, the estrogen receptor (ER) ( 2–4 ). Clinicians now routinely use tissue ER content to individualize antiestrogen therapy for breast cancer patients ( 5 ).

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