On Doctoring MEDLINE searches, with reference librarian comments, March 2000

The question was

What is the benefit of using "SERMS" on the risk of breast cancer in post-menapausal women?

1     Breast neoplasms/ or Estrogen antagonists/ or Tamoxifen/    results=40649   
2     *Breast neoplasms/ or *Estrogen antagonists/ or *Tamoxifen/    results= 33093   
3     exp breast neoplasms/ and exp estrogen antagonists/ and exp    results= 2351   
tamoxifen/
4     *Breast neoplasms/ and *Estrogen antagonists/ and    results= 224   
*Tamoxifen/
5     *Tamoxifen/tu [Therapeutic Use]    results= 876   
6     *Estrogen Antagonists/tu [Therapeutic Use]    results= 347   

Reference Librarian comments

Though I didn't replicate your search, it looks to me like you didn't really nail-down the "SERMS" idea. Here are a couple of GENERAL tips, and then I'll explain a little difficulty with "Serms" the term.

In general, try to separate your question into single ideas. The Ovid interface invites you to do otherwise, but it's all wrong. In set one, you checked three quite different ideas, and thus the set is huge and messy. In set #2, you did a good thing by using the "focus" check-box, but you're still checking off too many subjects.

Try to think like this, one step at a time...

a) breast cancer
b) serms
c) put those two concepts together
d) limit somehow to post-menopausal women, either by ANDing to a postmenopause subject-heading, or simply limiting by AGE, or do both

"Serms" was a new term for me, so to define it for myself, I asked Ovid Medline to give me a few articles where "serms" was in the title field (serms.ti.), and then I checked the "review article" check-box.

I quickly learned:

"Selective oestrogen receptor modulators (SERMs) constitute a group of new drugs which mimic oestrogen in some organs and tissues but have an oestrogen antagonistic mode of action in other tissues. ... ... ... In postmenopausal women these compounds have a favourable effect on lipoprotein cholesterol levels in the blood and bone mineral density, thereby reducing fracture risk, especially in the vertebral column. In contrast to oestrogen therapy SERMs reduce the risk of mammary carcinoma. ... ... ... Currently tamoxifen and raloxifene are the best known SERMs. "

Darn. It looks like the new term "SERM" (an acronym for "Selective estrogen-receptor modulators") simply makes a handy grouping of some well-known drugs (tamoxifen, etc.). It's handy for up-to-date, convenient "doctor talk," but big old MEDLINE will take a little longer to properly identify this term.

(What is he saying?!)

Well, it's a tricky search, in that you have to decide whether you're going to hang on to your "Serm" term. In your strategy, you didn't. (Probably because Ovid didn't really want you to.)

But, you CAN force the Ovid system to recognize "serms" -- and if you do, you get some articles. But when I checked the INDEXING of those articles, I see that they're really indexed sometimes under "hormone replacement therapy" and/or "estrogen replacement therapy" and/or tamoxifen etc.

So, what might I do, if this question were mine?

(I might just simplify and re-word the question to this: tamoxifen and breast cancer prevention...)

But I took the broader, "SERMS" road and did something like this:

Medline 1991 to January 2000

#
Search History
Results
1
exp *Estrogen antagonists/ae,tu [Adverse Effects, Therapeutic Use]
1704
2
serms.mp.
47
3
selective estrogen-receptor modulator$.mp.
112
4
selective oestrogen-receptor modulator$.mp.
11
5
1 or 2 or 3 or 4
1807
6
exp breast neoplasms/et,pc
5276
7
5 and 6
256
8
exp Postmenopause/
3696
9
7 and 8
16
10
limit 7 to (middle age < 45 to 64 years > or "aged < 65 and over >" or "aged,
80 and over")
107
11
9 or 10
112
12
limit 11 to (human and english language)
96

==== Here are a few SELECTED references from those 96 ====

<1>
AN 99426351
AU Mattimoe D. Newton W.
IN University of North Carolina, Chapel Hill, USA.
TI Does raloxifene reduce breast cancer risk?.
SO Journal of Family Practice. 48(9):659-60, 1999 Sep.
LM Pre-1993 at Dana,1993-date at MFHSL.

<2>
AN 99176992
AU Spencer CP. Morris EP. Rymer JM.
IN Department of Obstetrics and Gynaecology, St Thomas' Hospital, London,
United Kingdom.
TI Selective estrogen receptor
modulators: Women's panacea for the next millennium?.
[Review] [120 refs]
SO American Journal of Obstetrics & Gynecology. 180(3 Pt 1):763-70, 1999 Mar.
LM Pre-1993 Dana; 1993-dateMFHSL;for Web access-check catalog
AB The purpose of this review is to assimilate relevant experimental and
clinical information available on selective
estrogen receptor modulators with respect
to their potential use as agents to improve women's health in the
postmenopausal years. In addition, the mechanisms of action of these drugs
are outlined. Selective estrogen receptor
modulators represent an exciting group of
antiestrogens that possess agonist action on bone, lipids,
and lipoproteins and antagonistic action in the endometrium and
breast. Thus in theory these drugs may preserve bone density
and reduce the risk of osteoporotic fracture and coronary heart disease at
the same time that they lower the incidences of breast and
endometrial neoplasms. Short-term data with the use of
raloxifene suggest that bone is preserved and lipid profiles are less
atherogenic. Long-term studies are needed to determine whether raloxifene or
other selective estrogen receptor
modulators are associated with any decrease in the risk of
breast or endometrial cancer. [References: 120]

<3>
AN 99155136
AU Sweeney FW. Newton WP.
IN Department of Family Medicine, University of North Carolina - Chapel Hill,
USA.
TI Tamoxifen for the prevention of breast cancer in high-risk
women.
SO Journal of Family Practice. 48(2):90-1, 1999 Feb.
LM Pre-1993 at Dana,1993-date at MFHSL.

<4>
AN 98336017
AU Veronesi U. Maisonneuve P. Costa A. Sacchini V. Maltoni C. Robertson C.
Rotmensz N. Boyle P.
IN European Institute of Oncology, Milan, Italy.
TI Prevention of breast cancer with tamoxifen: preliminary
findings from the Italian randomised trial among hysterectomised women.
Italian Tamoxifen Prevention Study [see comments].
CM Comment in: Lancet 1998 Jul 11;352(9122):80-1
SO Lancet. 352(9122):93-7, 1998 Jul 11.
LM Dana(complete) &MFHSL(1990-date);also Web,check catalog .
AB BACKGROUND: Tamoxifen is a candidate chemopreventive agent in
breast cancer, although the drug may be associated with the
development of endometrial cancer. Therefore we did a trial in
hysterectomised women of tamoxifen as a chemopreventive. METHODS: In October,
1992, we started a double-blind placebo-controlled, randomised trial of
tamoxifen in women (mainly in Italy) who did not have breast
cancer and who had had a hysterectomy. Women were randomised to receive
tamoxifen 20 mg per day or placebo, both orally for 5 years. The original
plan was to follow the intervention phase by 5 years' follow-up. In June,
1997, the trialists and the data-monitoring committee decided to end
recruitment primarily because of the number of women dropping out of the
study. Recruitment ended on July 11, 1997, and the study will continue as
planned. The primary endpoints are the occurrence of and deaths from
breast cancer. This preliminary interim analysis is based on
intention-to-treat. FINDINGS: 5408 women were randomised; participating women
have a median follow-up of 46 months for major endpoints. 41 cases of
breast cancer occurred so far; there have been no deaths
from breast cancer. There is no difference in
breast-cancer frequency between the placebo (22 cases) and
tamoxifen (19) arms. There is a statistically significant reduction of
breast cancer among women receiving tamoxifen who also used
hormone-replacement therapy during the trial: among 390 women on such therapy
and allocated to placebo, we found eight cases of breast
cancer compared with one case among 362 women allocated to tamoxifen.
Compared with the placebo group, there was a significantly increased risk of
vascular events and hypertriglyceridaemia among women on tamoxifen.
INTERPRETATION: Although this preliminary analysis has low power, in this
cohort of women at low-to-normal risk of breast cancer, the
postulated protective effects of tamoxifen are not yet apparent. Women using
hormone-replacement therapy appear to have benefited from use of tamoxifen.
There were no deaths from breast cancer recorded in women in
the study. It is essential to continue follow-up to quantify the long-term
risks and benefits of tamoxifen therapy.

<5>
AN 98221039
AU Bruzzi P.
TI Tamoxifen for the prevention of breast cancer. Important
questions remain unanswered, and existing trials should continue [editorial;
comment].
CM Comment on: BMJ 1998 Apr 18;316(7139):1187
SO BMJ. 316(7139):1181-2, 1998 Apr 18.
LM Pre-1993 at Dana,1993-date at MFHSL.

<6>
AN 97345292
AU Jordan VC.
TI After the menopause: tamoxifen and other new prevention maintenance
therapies [editorial].
SO Journal of Womens Health. 6(3):257-9, 1997 Jun.
LM Matthews-Fuller Health Sciences Library (MFHSL).