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Time dependent effects of adjuvant tamoxifen therapy on cerebrovascular disease: results from a randomised trial

Rosell, J.; Nordenskjold, B.; Bengtsson, N-O; Fornander, T.; Hatschek, T.; Lindman, H.; Malmström, Per LU ; Wallgren, A.; Stal, O. and Carstensen, J. (2011) In British Journal of Cancer 104(6). p.899-902
Abstract
BACKGROUND: Tamoxifen has been associated with an increased risk of stroke. There is, however, little information on the effect in the post-treatment period. Using data from the Swedish Breast Cancer Group adjuvant trial of 5 vs 2 years of tamoxifen treatment, we now report both short-term and long-term effects on morbidity as well as mortality because of cerebrovascular disease. METHODS: Data from the Swedish National Hospital Discharge Registry combined with information from the Swedish Cause of Death Registry was used to define events of disease. Hazard ratios (HRs) were estimated using Cox regression. RESULTS: Comparing patients randomised to 5 years of tamoxifen with patients randomised to 2 years of tamoxifen, the incidence of... (More)
BACKGROUND: Tamoxifen has been associated with an increased risk of stroke. There is, however, little information on the effect in the post-treatment period. Using data from the Swedish Breast Cancer Group adjuvant trial of 5 vs 2 years of tamoxifen treatment, we now report both short-term and long-term effects on morbidity as well as mortality because of cerebrovascular disease. METHODS: Data from the Swedish National Hospital Discharge Registry combined with information from the Swedish Cause of Death Registry was used to define events of disease. Hazard ratios (HRs) were estimated using Cox regression. RESULTS: Comparing patients randomised to 5 years of tamoxifen with patients randomised to 2 years of tamoxifen, the incidence of cerebrovascular diseases was increased (HR 1.70, 95% CI 1.05-2.75) during the active treatment phase and reduced after the active treatment period (HR 0.78, 95% CI 0.63-0.96), and the difference in HR between the two time-periods was significant (P 0.0033). The mortality from cerebrovascular diseases was increased during the treatment period (HR 3.18, 95% CI 1.03-9.87) and decreased during the post-treatment period (HR 0.60, 95% CI 0.40-0.90) with a significant difference in HR between the two periods of follow-up (P=0.0066). Similar results were seen for subgroups of cerebrovascular diseases, such as stroke and ischaemic stroke. CONCLUSION: In an adjuvant setting, tamoxifen was associated with an increased risk of cerebrovascular disease during treatment, but a decreased risk in the post-treatment period. British Journal of Cancer (2011) 104, 899-902. doi: 10.1038/bjc. 2011.45 www. bjcancer. com (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
breast cancer, tamoxifen, adjuvant treatment, adverse events, cerebrovascular disease
in
British Journal of Cancer
volume
104
issue
6
pages
899 - 902
publisher
Nature Publishing Group
external identifiers
  • wos:000288437500002
  • scopus:79952696979
ISSN
1532-1827
DOI
10.1038/bjc.2011.45
language
English
LU publication?
yes
id
da9b5ef3-822c-49a1-8efe-398a7d61c66c (old id 1926109)
date added to LUP
2011-05-02 08:38:42
date last changed
2017-01-01 04:05:25
@article{da9b5ef3-822c-49a1-8efe-398a7d61c66c,
  abstract     = {BACKGROUND: Tamoxifen has been associated with an increased risk of stroke. There is, however, little information on the effect in the post-treatment period. Using data from the Swedish Breast Cancer Group adjuvant trial of 5 vs 2 years of tamoxifen treatment, we now report both short-term and long-term effects on morbidity as well as mortality because of cerebrovascular disease. METHODS: Data from the Swedish National Hospital Discharge Registry combined with information from the Swedish Cause of Death Registry was used to define events of disease. Hazard ratios (HRs) were estimated using Cox regression. RESULTS: Comparing patients randomised to 5 years of tamoxifen with patients randomised to 2 years of tamoxifen, the incidence of cerebrovascular diseases was increased (HR 1.70, 95% CI 1.05-2.75) during the active treatment phase and reduced after the active treatment period (HR 0.78, 95% CI 0.63-0.96), and the difference in HR between the two time-periods was significant (P 0.0033). The mortality from cerebrovascular diseases was increased during the treatment period (HR 3.18, 95% CI 1.03-9.87) and decreased during the post-treatment period (HR 0.60, 95% CI 0.40-0.90) with a significant difference in HR between the two periods of follow-up (P=0.0066). Similar results were seen for subgroups of cerebrovascular diseases, such as stroke and ischaemic stroke. CONCLUSION: In an adjuvant setting, tamoxifen was associated with an increased risk of cerebrovascular disease during treatment, but a decreased risk in the post-treatment period. British Journal of Cancer (2011) 104, 899-902. doi: 10.1038/bjc. 2011.45 www. bjcancer. com},
  author       = {Rosell, J. and Nordenskjold, B. and Bengtsson, N-O and Fornander, T. and Hatschek, T. and Lindman, H. and Malmström, Per and Wallgren, A. and Stal, O. and Carstensen, J.},
  issn         = {1532-1827},
  keyword      = {breast cancer,tamoxifen,adjuvant treatment,adverse events,cerebrovascular disease},
  language     = {eng},
  number       = {6},
  pages        = {899--902},
  publisher    = {Nature Publishing Group},
  series       = {British Journal of Cancer},
  title        = {Time dependent effects of adjuvant tamoxifen therapy on cerebrovascular disease: results from a randomised trial},
  url          = {http://dx.doi.org/10.1038/bjc.2011.45},
  volume       = {104},
  year         = {2011},
}