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Breast cancer survival and incidence of second primary cancers after 30 years in a randomized study of two versus five years of adjuvant tamoxifen therapy

Nordenskjöld, Anna ; Fohlin, Helena ; Rosell, Johan ; Bengtsson, Nils Olof ; Fornander, Tommy ; Hatschek, Thomas ; Lindman, Henrik ; Malmström, Per LU ; Rydén, Lisa LU orcid and Wallgren, Arne , et al. (2023) In Breast 71. p.63-68
Abstract

Background: Tamoxifen is an established treatment for breast cancer, but its long-term effects on survival and on secondary cancers are not fully evaluated. Material and methods: We studied 30 years outcome of 4124 postmenopausal patients who were randomized to receive (totally) two or five years of adjuvant tamoxifen. Results: After 5 years of follow-up, when tamoxifen treatment was finished in both groups, until 15 years of follow-up, overall mortality (HR 0.80, 95% CI 0.72–0.90, p < 0.001), breast cancer mortality for all patients (HR 0.80, 95% CI 0.68–0.94, p = 0.006) and breast cancer mortality for patients with estrogen receptor positive disease (HR 0.67, 95% CI 0.55–0.83, p < 0.001) were significantly reduced in the... (More)

Background: Tamoxifen is an established treatment for breast cancer, but its long-term effects on survival and on secondary cancers are not fully evaluated. Material and methods: We studied 30 years outcome of 4124 postmenopausal patients who were randomized to receive (totally) two or five years of adjuvant tamoxifen. Results: After 5 years of follow-up, when tamoxifen treatment was finished in both groups, until 15 years of follow-up, overall mortality (HR 0.80, 95% CI 0.72–0.90, p < 0.001), breast cancer mortality for all patients (HR 0.80, 95% CI 0.68–0.94, p = 0.006) and breast cancer mortality for patients with estrogen receptor positive disease (HR 0.67, 95% CI 0.55–0.83, p < 0.001) were significantly reduced in the five-year group as compared to the two-year group. After 15 years, the difference remained but did not further increase. In the five-year group, the incidence of contralateral breast cancer was gradually reduced during the entire period of observation. The incidence of lung cancer was also reduced in the five-year group. In contrast there was an increased endometrial cancer incidence in the five-year group and for those receiving 40 mg of tamoxifen this incidence was further increased. Conclusion: Three more years of tamoxifen therapy reduced the risk of breast cancer mortality. The difference was established during the first 15 years after randomization. Moreover, the incidence of contralateral breast cancer gradually decreased for 30 years. The incidence of lung cancer was reduced in the five-year group. In contrast the incidence of endometrial cancer was increased.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Breast
volume
71
pages
6 pages
publisher
Churchill Livingstone
external identifiers
  • pmid:37517154
  • scopus:85166060582
ISSN
0960-9776
DOI
10.1016/j.breast.2023.07.010
language
English
LU publication?
yes
id
048bb1bc-99b9-4eec-94e8-690fd8d6a68f
date added to LUP
2023-09-20 11:42:16
date last changed
2024-04-19 01:10:24
@article{048bb1bc-99b9-4eec-94e8-690fd8d6a68f,
  abstract     = {{<p>Background: Tamoxifen is an established treatment for breast cancer, but its long-term effects on survival and on secondary cancers are not fully evaluated. Material and methods: We studied 30 years outcome of 4124 postmenopausal patients who were randomized to receive (totally) two or five years of adjuvant tamoxifen. Results: After 5 years of follow-up, when tamoxifen treatment was finished in both groups, until 15 years of follow-up, overall mortality (HR 0.80, 95% CI 0.72–0.90, p &lt; 0.001), breast cancer mortality for all patients (HR 0.80, 95% CI 0.68–0.94, p = 0.006) and breast cancer mortality for patients with estrogen receptor positive disease (HR 0.67, 95% CI 0.55–0.83, p &lt; 0.001) were significantly reduced in the five-year group as compared to the two-year group. After 15 years, the difference remained but did not further increase. In the five-year group, the incidence of contralateral breast cancer was gradually reduced during the entire period of observation. The incidence of lung cancer was also reduced in the five-year group. In contrast there was an increased endometrial cancer incidence in the five-year group and for those receiving 40 mg of tamoxifen this incidence was further increased. Conclusion: Three more years of tamoxifen therapy reduced the risk of breast cancer mortality. The difference was established during the first 15 years after randomization. Moreover, the incidence of contralateral breast cancer gradually decreased for 30 years. The incidence of lung cancer was reduced in the five-year group. In contrast the incidence of endometrial cancer was increased.</p>}},
  author       = {{Nordenskjöld, Anna and Fohlin, Helena and Rosell, Johan and Bengtsson, Nils Olof and Fornander, Tommy and Hatschek, Thomas and Lindman, Henrik and Malmström, Per and Rydén, Lisa and Wallgren, Arne and Stål, Olle and Nordenskjöld, Bo}},
  issn         = {{0960-9776}},
  language     = {{eng}},
  pages        = {{63--68}},
  publisher    = {{Churchill Livingstone}},
  series       = {{Breast}},
  title        = {{Breast cancer survival and incidence of second primary cancers after 30 years in a randomized study of two versus five years of adjuvant tamoxifen therapy}},
  url          = {{http://dx.doi.org/10.1016/j.breast.2023.07.010}},
  doi          = {{10.1016/j.breast.2023.07.010}},
  volume       = {{71}},
  year         = {{2023}},
}