Antiestrogens as the treatment of choice in breast cancer have become so entrenched in our thinking that we tend to forget: prior to their introduction, high-dose estrogens were part of routine therapy in postmenopausal women with breast cancer. The recent negative publicity regarding hormone-replacement (mainly with estrogens) after the menopause has introduced another dilemma: where to strike the balance between osteoporosis, cardiosclerosis (fibrous hardening of heart tissue) and the many subjective discomforts of the menopause and the recognized risk of breast cancer? Attitudes change and swing like a pendulum; what was acceptable yesterday is strictly forbidden today and may be up to standard tomorrow again. The interplay between estrogens ? physiological or administered ? and antiestrogens has been oversimplified and requires some rethinking.
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