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Effects of adjuvant tamoxifen therapy on cardiac disease: results from a randomized trial with long-term follow-up
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för hälso- och vårdutveckling, Regionalt cancercentrum.
Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Centrum för kirurgi, ortopedi och cancervård, Onkologiska kliniken US.
Umeå University Hospital, Sweden .
Karolinska University Hospital, Sweden .
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2013 (engelsk)Inngår i: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 138, nr 2, s. 467-473Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Tamoxifen is associated with a reduced risk of coronary heart disease (CHD). However, there are few reports on long-term effects. Using data from a large Swedish randomized trial of 5 and 2 years of adjuvant tamoxifen in women with early breast cancer, we here present results on morbidity and mortality from cardiac diseases during treatment and long-term after treatment. A total of 4,150 patients were breast cancer recurrence-free after 2 years. Data from the Swedish National Hospital Discharge Registry combined with information from the Swedish Cause of Death Registry were used to define events of disease. Hazard ratios were estimated using Cox regression. Patients assigned to 5 years in comparison with 2 years of postoperative tamoxifen experienced a reduced incidence of CHD [hazard ratio (HR), 0.83; 95 % CI 0.70-1.00], especially apparent during the active treatment period (HR 0.65; 95 % CI 0.43-1.00). The mortality from CHD was significantly reduced (HR 0.72; 95 % CI 0.53-0.97). During the active treatment, the morbidity of other heart diseases was also significantly reduced (HR 0.40; 95 % CI 0.25-0.64) but not after treatment stopped (HR 1.06; 95 % CI 0.87-1.30). Similar results were seen for both heart failure and atrial fibrillation/flutter. As compared to 2 years of therapy, 5 years of postoperative tamoxifen therapy prevents CHD as well as other heart diseases. The risk reduction is most apparent during the active treatment period, and later tends to diminish.

sted, utgiver, år, opplag, sider
SPRINGER, 233 SPRING ST, NEW YORK, NY 10013 USA , 2013. Vol. 138, nr 2, s. 467-473
Emneord [en]
Breast cancer, Tamoxifen, Adjuvant treatment, Adverse events, Heart failure, Coronary heart disease
HSV kategori
Identifikatorer
URN: urn:nbn:se:liu:diva-91931DOI: 10.1007/s10549-013-2457-6ISI: 000316821300012OAI: oai:DiVA.org:liu-91931DiVA, id: diva2:619795
Tilgjengelig fra: 2013-05-06 Laget: 2013-05-06 Sist oppdatert: 2017-12-06
Inngår i avhandling
1. Long-term effects of adjuvant tamoxifen treatment on cardiovascular disease and cancer
Åpne denne publikasjonen i ny fane eller vindu >>Long-term effects of adjuvant tamoxifen treatment on cardiovascular disease and cancer
2014 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

The aims of this thesis were to investigate the long-term effects of adjuvant tamoxifen treatment on breast cancer recurrence and mortality, cardiovascular disease, and the incidence of secondary cancer.

Between 1982 and 1992, postmenopausal patients with early stage breast cancer were included in a randomized clinical study of 2 or 5 years of postoperative tamoxifen therapy. The trial was planned by the Swedish Breast Cancer Group, and it included 4610 patients. Follow-up on causes of death, hospitalizations and secondary cancers were obtained from national population-based registries. 

All-cause mortality, breast cancer-specific mortality and mortality from coronary heart disease were decreased in the 5-year group, but the incidence of endometrial cancer was increased (Paper I). The incidence and mortality of cerebrovascular diseases were increased during the active treatment phase, and reduced after the active treatment (Paper II). Similar results were seen for subgroups of cerebrovascular diseases such as stroke and ischemic stroke. In the 5-year group, the morbidity from coronary heart disease was reduced during treatment but not after treatment was stopped (Paper III). This was the case also for heart failure and for atrial fibrillation/flutter. For secondary cancers the lung cancer risk was reduced, as well as the lung cancer mortality (Paper IV). An increased risk was observed for endometrial cancer, but appeared to decrease over time. The risk of contralateral breast cancer was reduced, with most of the reduction after treatment was stopped. For distance recurrences the risk was reduced both during treatment and a few years after treatment was stopped. The breast cancer mortality was also reduced, especially during the post-treatment phase.

sted, utgiver, år, opplag, sider
Linköping: Linköping University Electronic Press, 2014. s. 45
Serie
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1430
Emneord
Adjuvant, adverse events, breast cancer, cerebrovascular disease, coronary heart disease, heart failure, lung cancer, second primary cancer, tamoxifen
HSV kategori
Identifikatorer
urn:nbn:se:liu:diva-112085 (URN)10.3384/diss.diva-112085 (DOI)978-91-7519-182-9 (ISBN)
Disputas
2014-12-19, Eken, ingång 65, Campus US, Linköpings universitet, Linköping, 09:00 (svensk)
Opponent
Veileder
Tilgjengelig fra: 2014-11-21 Laget: 2014-11-13 Sist oppdatert: 2019-11-19bibliografisk kontrollert

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