Tamoxifen and Risk of Contralateral Bca

ABSTRACT: Tamoxifen Therapy for Primary Breast Cancer and Risk of Contralateral Breast Cancer [07/04/2001; Journal of the National Cancer Institute]

Background: Women diagnosed with breast cancer have a twofold to sixfold greater risk of developing contralateral breast cancer than women in the general population have of developing a first breast cancer. Tamoxifen therapy reduces this risk, but it is unclear if this benefit exists for both estrogen receptor (ER)-positive and ER-negative contralateral tumors.

Methods: Using data from a population-based tumor registry that collects information on the ER status of breast tumors, we followed 8981 women residing in western Washington State who were diagnosed with a primary unilateral invasive breast cancer during the period from 1990 through 1998 to identify cases of contralateral breast cancer.

We restricted our analyses to women who were at least 50 years old and whose first breast cancer had a localized or regional stage; women who received adjuvant hormonal therapy but not chemotherapy (n = 4654) were classified as tamoxifen users, while those who received neither adjuvant hormonal therapy nor chemotherapy (n = 4327) were classified as nonusers of tamoxifen. By reviewing selected patient abstracts, we estimated that 94% of the subjects were classified correctly with respect to tamoxifen use.

The risk of contralateral breast cancer associated with tamoxifen use was estimated with the use of Cox regression. All statistical tests were two-sided.

Results: Of the 89 tamoxifen users and 100 nonusers of tamoxifen diagnosed with contralateral breast cancer, 112 had ER-positive tumors, 20 had ER-negative tumors, and 57 had tumors with an ER status that was unknown or had not been determined by an immunohistochemical assay.

The risk of developing an ER-positive and an ER-negative contralateral tumor among tamoxifen users was 0.8 (95% confidence interval [CI] = 0.5 to 1.1) and 4.9 (95% CI = 1.4 to 17.4), respectively, times that of nonusers of tamoxifen. This difference in risk by ER status was statistically significant (P<.0001).

Conclusions: Tamoxifen use appears to decrease the risk of ER-positive contralateral breast tumors, but it appears to increase the risk of ER-negative contralateral tumors.

Ann's NOTE: I conclude that Tamoxifen benefits a very small number of women. Compare 89 breast cancers in those taking Tamoxifen versus 100 in those not taking it. Troublesome. As always, we need to KNOW who will benefit from a drug with so many adverse effects. PLEASE READ MUSA MAYER's REMARKS BELOW.


Author Musa Mayer Remarks on this Study

Read the AP report to see what she means

AP's Take:ER negative tumors develop After Tam Use

Associated Press Article Read Musa Mayer's Comments

New York Time's Version
DNA Methylation Prfle Predicts Recurrence Risk:Tam/BCa

Abstract # 525 ASCO, 2004

Benefits/Risk Tamoxifen Similar White & Black Women

JNCI, 12/04 NCI Press Release


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