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Effects of adjuvant tamoxifen therapy on cardiac disease: results from a randomized trial with long-term follow-up
Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Regional Cancer Center South East Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Oncology.
Umeå University Hospital, Sweden .
Karolinska University Hospital, Sweden .
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2013 (English)In: Breast Cancer Research and Treatment, ISSN 0167-6806, E-ISSN 1573-7217, Vol. 138, no 2, 467-473 p.Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
SPRINGER, 233 SPRING ST, NEW YORK, NY 10013 USA , 2013. Vol. 138, no 2, 467-473 p.
Keyword [en]
Breast cancer, Tamoxifen, Adjuvant treatment, Adverse events, Heart failure, Coronary heart disease
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-91931DOI: 10.1007/s10549-013-2457-6ISI: 000316821300012OAI: oai:DiVA.org:liu-91931DiVA: diva2:619795
Available from: 2013-05-06 Created: 2013-05-06 Last updated: 2017-12-06
In thesis
1. Long-term effects of adjuvant tamoxifen treatment on cardiovascular disease and cancer
Open this publication in new window or tab >>Long-term effects of adjuvant tamoxifen treatment on cardiovascular disease and cancer
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
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.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2014. 45 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1430
Keyword
Adjuvant, adverse events, breast cancer, cerebrovascular disease, coronary heart disease, heart failure, lung cancer, second primary cancer, tamoxifen
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:liu:diva-112085 (URN)10.3384/diss.diva-112085 (DOI)978-91-7519-182-9 (ISBN)
Public defence
2014-12-19, Eken, ingång 65, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2014-11-21 Created: 2014-11-13 Last updated: 2014-11-21Bibliographically approved

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Rosell, JohanNordenskjöld, BoStål, OlleCarstensen, John

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