Differences in power, age, risk, compliance, the use of ERT, and follow-up in the European studies may all be relevant. The long-term use of tamoxifen for prevention carries significant risks. If raloxifene can be given long term, then continuing the prevention of tumors may be possible if raloxifene is proven safe. The word prevention has been the subject of polemics. Every day that breast cancer is delayed is a day that it is prevented.
Risk reduction is technically a more accurate phrase but lacks meaning to many women.
Novel approaches to chemoprevention are being explored. Naturally occurring compounds or their analogues are being assessed. A randomized clinical trial of 4-HPR is being tested in women in Italy to reduce contralateral breast cancer, but no results are available. New approaches using substances derived from plants, such as vegetables, are being pursued. Strategies to reduce 16 alpha-OHE1 have been explored.