© 1998 by Oxford University Press
Journal of the National Cancer Institute, Vol. 90, No. 18, 1371-1388,
September 16, 1998
©Copyright 1998 Oxford University Press
ARTICLES |
Tamoxifen for Prevention of Breast Cancer: Report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study
Affiliations of authors: B. Fisher, National Surgical Adjuvant Breast and Bowel Project (NSABP) and Allegheny University of the Health Sciences, Pittsburgh, PA; J. P. Costantino, C. K. Redmond, W. M. Cronin, V. Vogel, University of Pittsburgh; D. L. Wickerham, N. Wolmark, NSABP and Allegheny General Hospital; M. Kavanah, Boston Medical Center, MA; A. Robidoux, Hotel-Dieu de Montreal, Quebec, Canada; N. Dimitrov, Michigan State University, East Lansing; J. Atkins, Southeast Cancer Control Consortium, Winston-Salem, NC; M. Daly, Fox Chase Cancer Center, Cheltenham, PA; S. Wieand, NSABP Biostatistical Center, University of Pittsburgh; E. Tan-Chiu, Allegheny University of the Health Sciences; L. Ford, National Cancer Institute, Bethesda, MD.
Correspondence to: Bernard Fisher, M.D., Scientific Director, Allegheny University of the Health Sciences, Four Allegheny Center, Suite 602, Pittsburgh, PA 15212-5234 (BFISHER1{at}aherf.edu).
Abstract
Background: The finding of a decrease in contralateral breast cancer incidence following tamoxifen administration for adjuvant therapy led to the concept that the drug might play a role in breast cancer prevention. To test this hypothesis, the National Surgical Adjuvant Breast and Bowel Project initiated the Breast Cancer Prevention Trial (P-1) in 1992. Methods: Women (N = 13388) at increased risk for breast cancer because they 1) were 60 years of age or older, 2) were 35–59 years of age with a 5-year predicted risk for breast cancer of at least 1.66%, or 3) had a history of lobular carcinoma in situ were randomly assigned to receive placebo (n = 6707) or 20 mg/day tamoxifen (n = 6681) for 5 years. Gail's algorithm, based on a multivariate logistic regression model using combinations of risk factors, was used to estimate the probability (risk) of occurrence of breast cancer over time. Results: Tamoxifen reduced the risk of invasive breast cancer by 49% (two-sided P<.00001), with cumulative incidence through 69 months of follow-up of 43.4 versus 22.0 per 1000 women in the placebo and tamoxifen groups, respectively. The decreased risk occurred in women aged 49 years or younger (44%), 50–59 years (51%), and 60 years or older (55%); risk was also reduced in women with a history of lobular carcinoma in situ (56%) or atypical hyperplasia (86%) and in those with any category of predicted 5-year risk. Tamoxifen reduced the risk of noninvasive breast cancer by 50% (two-sided P<.002). Tamoxifen reduced the occurrence of estrogen receptor-positive tumors by 69%, but no difference in the occurrence of estrogen receptor-negative tumors was seen. Tamoxifen administration did not alter the average annual rate of ischemic heart disease; however, a reduction in hip, radius (Colles'), and spine fractures was observed. The rate of endometrial cancer was increased in the tamoxifen group (risk ratio = 2.53; 95% confidence interval = 1.35–4.97); this increased risk occurred predominantly in women aged 50 years or older. All endometrial cancers in the tamoxifen group were stage I (localized disease); no endometrial cancer deaths have occurred in this group. No liver cancers or increase in colon, rectal, ovarian, or other tumors was observed in the tamoxifen group. The rates of stroke, pulmonary embolism, and deep-vein thrombosis were elevated in the tamoxifen group; these events occurred more frequently in women aged 50 years or older. Conclusions: Tamoxifen decreases the incidence of invasive and noninvasive breast cancer. Despite side effects resulting from administration of tamoxifen, its use as a breast cancer preventive agent is appropriate in many women at increased risk for the disease. [J Natl Cancer Inst 1998;90:1371–88]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  V. C. Jordan The 38th David A. Karnofsky Lecture: The Paradoxical Actions of Estrogen in Breast Cancer--Survival or Death? J. Clin. Oncol., June 20, 2008; 26(18): 3073 - 3082. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Grady, J. A. Cauley, M. J. Geiger, M. Kornitzer, L. Mosca, P. Collins, N. K. Wenger, J. Song, J. Mershon, E. Barrett-Connor, et al. Reduced Incidence of Invasive Breast Cancer With Raloxifene Among Women at Increased Coronary Risk J Natl Cancer Inst, June 18, 2008; 100(12): 854 - 861. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. C. Jordan The Rise of Raloxifene and the Fall of Invasive Breast Cancer J Natl Cancer Inst, June 18, 2008; 100(12): 831 - 833. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Gehrig, J. Lane, and M. I. O'Connor Osteoporosis: Management and Treatment Strategies for Orthopaedic Surgeons J. Bone Joint Surg. Am., June 1, 2008; 90(6): 1362 - 1374. [Full Text] [PDF]
|
|
|
|
 |
|
 W. H. Geerts, D. Bergqvist, G. F. Pineo, J. A. Heit, C. M. Samama, M. R. Lassen, and C. W. Colwell Prevention of Venous Thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 381S - 453S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Berube, C. Diorio, and J. Brisson Multivitamin-multimineral supplement use and mammographic breast density Am. J. Clinical Nutrition, May 1, 2008; 87(5): 1400 - 1404. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. H. Barnett, S. Sheng, T. Howe Charn, A. Waheed, W. S. Sly, C.-Y. Lin, E. T. Liu, and B. S. Katzenellenbogen Estrogen Receptor Regulation of Carbonic Anhydrase XII through a Distal Enhancer in Breast Cancer Cancer Res., May 1, 2008; 68(9): 3505 - 3515. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. U. Lin and E. P. Winer Optimizing Endocrine Therapy for Estrogen Receptor-Positive Breast Cancer: Treating the Right Patients for the Right Length of Time J. Clin. Oncol., April 20, 2008; 26(12): 1919 - 1921. [Full Text] [PDF]
|
|
|
|
|
|
T. E. Rohan, A. Negassa, R. T. Chlebowski, L. Habel, A. McTiernan, M. Ginsberg, S. Wassertheil-Smoller, and D. L. Page Conjugated Equine Estrogen and Risk of Benign Proliferative Breast Disease: A Randomized Controlled Trial J Natl Cancer Inst, April 16, 2008; 100(8): 563 - 571. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Arpino, L. Wiechmann, C. K. Osborne, and R. Schiff Crosstalk between the Estrogen Receptor and the HER Tyrosine Kinase Receptor Family: Molecular Mechanism and Clinical Implications for Endocrine Therapy Resistance Endocr. Rev., April 1, 2008; 29(2): 217 - 233. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S.-C. Weng, Y. Kashida, S. K. Kulp, D. Wang, R. W. Brueggemeier, C. L. Shapiro, and C.-S. Chen Sensitizing estrogen receptor-negative breast cancer cells to tamoxifen with OSU-03012, a novel celecoxib-derived phosphoinositide-dependent protein kinase-1/Akt signaling inhibitor Mol. Cancer Ther., April 1, 2008; 7(4): 800 - 808. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Schaapveld, O. Visser, M. J. Louwman, E. G.E. de Vries, P. H.B. Willemse, R. Otter, W. T.A. van der Graaf, J.-W. W. Coebergh, and F. E. van Leeuwen Risk of New Primary Nonbreast Cancers After Breast Cancer Treatment: A Dutch Population-Based Study J. Clin. Oncol., March 10, 2008; 26(8): 1239 - 1246. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. U. Lin and E. P. Winer Advances in Adjuvant Endocrine Therapy for Postmenopausal Women J. Clin. Oncol., February 10, 2008; 26(5): 798 - 805. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. MacLean, S. Newberry, M. Maglione, M. McMahon, V. Ranganath, M. Suttorp, W. Mojica, M. Timmer, A. Alexander, M. McNamara, et al. Systematic Review: Comparative Effectiveness of Treatments to Prevent Fractures in Men and Women with Low Bone Density or Osteoporosis Ann Intern Med, February 5, 2008; 148(3): 197 - 213. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Yu, A. Park, E. Morris, L. Liberman, P. I. Borgen, and T. A. King MRI Screening in a Clinic Population with a Family History of Breast Cancer Ann. Surg. Oncol., February 1, 2008; 15(2): 452 - 461. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Owusu, D. S.M. Buist, T. S. Field, T. L. Lash, S. S. Thwin, A. M. Geiger, V. P. Quinn, F. Frost, M. Prout, M. U. Yood, et al. Predictors of Tamoxifen Discontinuation Among Older Women With Estrogen Receptor-Positive Breast Cancer J. Clin. Oncol., February 1, 2008; 26(4): 549 - 555. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. I. Sorosky Endometrial Cancer Obstet. Gynecol., February 1, 2008; 111(2): 436 - 447. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Fatouros, G. Baltoyiannis, and D. H. Roukos The Predominant Role of Surgery in the Prevention and New Trends in the Surgical Treatment of Women With BRCA1/2 Mutations Ann. Surg. Oncol., January 1, 2008; 15(1): 21 - 33. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. S. Rugo The breast cancer continuum in hormone-receptor positive breast cancer in postmenopausal women: evolving management options focusing on aromatase inhibitors Ann. Onc., January 1, 2008; 19(1): 16 - 27. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. R.J. H. Bird and S. M. Swain Cardiac Toxicity in Breast Cancer Survivors: Review of Potential Cardiac Problems Clin. Cancer Res., January 1, 2008; 14(1): 14 - 24. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. C. Jordan and B. W. O'Malley Selective Estrogen-Receptor Modulators and Antihormonal Resistance in Breast Cancer J. Clin. Oncol., December 20, 2007; 25(36): 5815 - 5824. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. H. Lyman, A. A. Khorana, A. Falanga, D. Clarke-Pearson, C. Flowers, M. Jahanzeb, A. Kakkar, N. M. Kuderer, M. N. Levine, H. Liebman, et al. American Society of Clinical Oncology Guideline: Recommendations for Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer J. Clin. Oncol., December 1, 2007; 25(34): 5490 - 5505. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Hosey, J. J. Gorski, M. M. Murray, J. E. Quinn, W. Y. Chung, G. E. Stewart, C. R. James, S. M. Farragher, J. M. Mulligan, A. N. Scott, et al. Molecular Basis for Estrogen Receptor {alpha} Deficiency in BRCA1-Linked Breast Cancer J Natl Cancer Inst, November 21, 2007; 99(22): 1683 - 1694. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. T. Chlebowski, G. L. Anderson, D. S. Lane, A. K. Aragaki, T. Rohan, S. Yasmeen, G. Sarto, C. A. Rosenberg, F. A. Hubbell, and For the Women's Health Initiative Investigators Predicting Risk of Breast Cancer in Postmenopausal Women by Hormone Receptor Status J Natl Cancer Inst, November 21, 2007; 99(22): 1695 - 1705. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
X. Wu, J. Lin, H. B. Grossman, M. Huang, J. Gu, C. J. Etzel, C. I. Amos, C. P. Dinney, and M. R. Spitz Projecting Individualized Probabilities of Developing Bladder Cancer in White Individuals J. Clin. Oncol., November 1, 2007; 25(31): 4974 - 4981. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 V. C. Jordan Tamoxifen or Raloxifene for Breast Cancer Chemoprevention: A Tale of Two Choices Point Cancer Epidemiol. Biomarkers Prev., November 1, 2007; 16(11): 2207 - 2209. [Full Text] [PDF]
|
|
|
|
|
|
C. Fabian Tamoxifen or Raloxifene in Postmenopausal Women for Prevention of Breast Cancer: A Tale of Two Choices Counterpoint Cancer Epidemiol. Biomarkers Prev., November 1, 2007; 16(11): 2210 - 2212. [Full Text] [PDF]
|
|
|
|
 |
|
 R. L. Sedjo, T. Byers, E. Barrera Jr., C. Cohen, E. T. H. Fontham, L. A. Newman, C. D. Runowicz, A. G. Thorson, M. J. Thun, E. Ward, et al. A Midpoint Assessment of the American Cancer Society Challenge Goal to Decrease Cancer Incidence by 25% Between 1992 and 2015 CA Cancer J Clin, November 1, 2007; 57(6): 326 - 340. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Sun, A. K. Sharma, R. W. Dellinger, A. S. Blevins-Primeau, R. M. Balliet, G. Chen, T. Boyiri, S. Amin, and P. Lazarus Glucuronidation of Active Tamoxifen Metabolites by the Human UDP Glucuronosyltransferases Drug Metab. Dispos., November 1, 2007; 35(11): 2006 - 2014. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Li, Y. Zhang, J. Hill, Q. Shen, H.-T. Kim, X. Xu, S. G. Hilsenbeck, R. P. Bissonnette, W. W. Lamph, and P. H. Brown The Rexinoid LG100268 Prevents the Development of Preinvasive and Invasive Estrogen Receptor Negative Tumors in MMTV-erbB2 Mice Clin. Cancer Res., October 15, 2007; 13(20): 6224 - 6231. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Tot The Theory of the Sick Breast Lobe and the Possible Consequences International Journal of Surgical Pathology, October 1, 2007; 15(4): 369 - 375. [Abstract] [PDF]
|
|
|
|
|
|
Y. Zheng, D. Sun, A. K. Sharma, G. Chen, S. Amin, and P. Lazarus Elimination of Antiestrogenic Effects of Active Tamoxifen Metabolites by Glucuronidation Drug Metab. Dispos., October 1, 2007; 35(10): 1942 - 1948. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. M. Schwartz, S. Woloshin, and H. G. Welch The Drug Facts Box: Providing Consumers with Simple Tabular Data on Drug Benefit and Harm Med Decis Making, October 1, 2007; 27(5): 655 - 662. [Abstract] [PDF]
|
|
|
|
|
|
M. C. Politi, P. K. J. Han, and N. F. Col Communicating the Uncertainty of Harms and Benefits of Medical Interventions Med Decis Making, October 1, 2007; 27(5): 681 - 695. [Abstract] [PDF]
|
|
|
|
 |
|
 W. Chu, A. Fyles, E. M. Sellers, D. R. McCready, J. Murphy, T. Pal, and S. A. Narod Association between CYP3A4 genotype and risk of endometrial cancer following tamoxifen use Carcinogenesis, October 1, 2007; 28(10): 2139 - 2142. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Fabian Low-Dose Tamoxifen for Combination Hormone Replacement Therapy Users J. Clin. Oncol., September 20, 2007; 25(27): 4162 - 4164. [Full Text] [PDF]
|
|
|
|
|
|
B. Arun, V. Valero, C. Logan, K. Broglio, E. Rivera, A. Brewster, G. Yin, M. Green, H. Kuerer, Y. Gong, et al. Comparison of Ductal Lavage and Random Periareolar Fine Needle Aspiration as Tissue Acquisition Methods in Early Breast Cancer Prevention Trials Clin. Cancer Res., August 15, 2007; 13(16): 4943 - 4948. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Kauh and F. R. Khuri Can Statins Pass the Aspirin Litmus Test in Cancer? J. Clin. Oncol., August 10, 2007; 25(23): 3395 - 3396. [Full Text] [PDF]
|
|
|
|
|
|
P. H. Brown Chemoprevention Clinical Trials: It Is Time to Turn Success into Progress Cancer Epidemiol. Biomarkers Prev., August 1, 2007; 16(8): 1531 - 1532. [Full Text] [PDF]
|
|
|
|
|
|
T. W.F. Yen, H. M. Kuerer, R. A. Ottesen, L. Rouse, J. C. Niland, S. B. Edge, R. L. Theriault, and J. C. Weeks Impact of Randomized Clinical Trial Results in the National Comprehensive Cancer Network on the Use of Tamoxifen After Breast Surgery for Ductal Carcinoma in Situ J. Clin. Oncol., August 1, 2007; 25(22): 3251 - 3258. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. M. Tamimi, C. Byrne, G. A. Colditz, and S. E. Hankinson Endogenous Hormone Levels, Mammographic Density, and Subsequent Risk of Breast Cancer in Postmenopausal Women J Natl Cancer Inst, August 1, 2007; 99(15): 1178 - 1187. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Brown, E. M. Tompkins, D. J. Boocock, E. A. Martin, P. B. Farmer, K. W. Turteltaub, E. Ubick, D. Hemingway, E. Horner-Glister, and I. N.H. White Tamoxifen Forms DNA Adducts in Human Colon after Administration of a Single [14C]-Labeled Therapeutic Dose Cancer Res., July 15, 2007; 67(14): 6995 - 7002. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Lippman and J. V. Heymach The Convergent Development of Molecular-Targeted Drugs for Cancer Treatment and Prevention Clin. Cancer Res., July 15, 2007; 13(14): 4035 - 4041. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. V. Dimitrov, P. Colucci, and S. Nagpal Some Aspects of the Endocrine Profile and Management of Hormone-Dependent Male Breast Cancer Oncologist, July 1, 2007; 12(7): 798 - 807. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M Johnson, M. Maleki-Dizaji, J. A Styles, and I. N H White Ishikawa cells exhibit differential gene expression profiles in response to oestradiol or 4-hydroxytamoxifen Endocr. Relat. Cancer, June 1, 2007; 14(2): 337 - 350. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Zheng, A. Kallio, and P. Harkonen Tamoxifen-Induced Rapid Death of MCF-7 Breast Cancer Cells Is Mediated via Extracellularly Signal-Regulated Kinase Signaling and Can Be Abrogated by Estrogen Endocrinology, June 1, 2007; 148(6): 2764 - 2777. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Z. Mai, G. L. Blackburn, and J.-R. Zhou Soy phytochemicals synergistically enhance the preventive effect of tamoxifen on the growth of estrogen-dependent human breast carcinoma in mice Carcinogenesis, June 1, 2007; 28(6): 1217 - 1223. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Bouchardy, E. Rapiti, S. Blagojevic, A.-T. Vlastos, and G. Vlastos Older Female Cancer Patients: Importance, Causes, and Consequences of Undertreatment J. Clin. Oncol., May 10, 2007; 25(14): 1858 - 1869. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Arpino, C. Gutierrez, H. Weiss, M. Rimawi, S. Massarweh, L. Bharwani, S. De Placido, C. K. Osborne, and R. Schiff Treatment of Human Epidermal Growth Factor Receptor 2-Overexpressing Breast Cancer Xenografts With Multiagent HER-Targeted Therapy J Natl Cancer Inst, May 2, 2007; 99(9): 694 - 705. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U. Veronesi, P. Maisonneuve, N. Rotmensz, B. Bonanni, P. Boyle, G. Viale, A. Costa, V. Sacchini, R. Travaglini, G. D'Aiuto, et al. Tamoxifen for the Prevention of Breast Cancer: Late Results of the Italian Randomized Tamoxifen Prevention Trial Among Women With Hysterectomy J Natl Cancer Inst, May 2, 2007; 99(9): 727 - 737. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. K. Goldenberg, V. L. Seewaldt, V. Scott, G. R. Bean, G. Broadwater, C. Fabian, B. Kimler, C. Zalles, and I. M. Lipkus Atypia in Random Periareolar Fine-Needle Aspiration Affects the Decision of Women at High Risk to Take Tamoxifen for Breast Cancer Chemoprevention Cancer Epidemiol. Biomarkers Prev., May 1, 2007; 16(5): 1032 - 1034. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. P. Madauss, E. T. Grygielko, S.-J. Deng, A. C. Sulpizio, T. B. Stanley, C. Wu, S. A. Short, S. K. Thompson, E. L. Stewart, N. J. Laping, et al. A Structural and in Vitro Characterization of Asoprisnil: A Selective Progesterone Receptor Modulator Mol. Endocrinol., May 1, 2007; 21(5): 1066 - 1081. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. I. Neugut, B. Lebwohl, and D. L. Hershman Cancer Chemoprevention: How Do We Know What Works? J. Clin. Oncol., April 20, 2007; 25(12): 1461 - 1462. [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Ravdin, K. A. Cronin, N. Howlader, C. D. Berg, R. T. Chlebowski, E. J. Feuer, B. K. Edwards, and D. A. Berry The Decrease in Breast-Cancer Incidence in 2003 in the United States N. Engl. J. Med., April 19, 2007; 356(16): 1670 - 1674. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Baglietto, D. R. English, J. L. Hopper, H. A. Morris, W. D. Tilley, and G. G. Giles Circulating Insulin-Like Growth Factor-I and Binding Protein-3 and the Risk of Breast Cancer Cancer Epidemiol. Biomarkers Prev., April 1, 2007; 16(4): 763 - 768. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. C. Jordan SERMs: Meeting the Promise of Multifunctional Medicines J Natl Cancer Inst, March 7, 2007; 99(5): 350 - 356. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Kerlikowske, L. Ichikawa, D. L. Miglioretti, D. S. M. Buist, P. M. Vacek, R. Smith-Bindman, B. Yankaskas, P. A. Carney, and R. Ballard-Barbash Longitudinal Measurement of Clinical Mammographic Breast Density to Improve Estimation of Breast Cancer Risk J Natl Cancer Inst, March 7, 2007; 99(5): 386 - 395. [Abstract] [Full Text] |