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Nakhlis F , Lazarus L , Hou N , Acharya S , Khan SA , Staradub VL , Rademaker AW , Morrow M
Tamoxifen use in patients with ductal carcinoma in situ and T1a/b N0 invasive carcinoma
Journal of the American College of Surgeons. 2005 ;201(5) :688-694
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Abstract
BACKGROUND: The purpose of this study was to determine how often patients with ductal carcinoma in situ and T1a/b N0 cancer are offered and accept tamoxifen for secondary chemoprevention. STUDY DESIGN: A retrospective review of 284 patients with T1a/b N0 invasive cancer treated between February 1995 and December 2001 and 129 patients with DCIS treated after September 1998 was carried out. Patient and tumor characteristics associated with being offered and accepting tamoxifen were compared. RESULTS: Tamoxifen was offered to 67% of the invasive cancer patients and accepted by 76% (51% of the entire group). Hormone receptor status was the only significant predictor of being offered tamoxifen (p = 0.004). Older age (p = 0.04), Caucasian race (p = 0.01), and parity (p = 0.04) in premenopausal women were significant predictors of tamoxifen acceptance on univariate analysis. After the publication of the National Surgical Adjuvant Breast and Bowel Project P-1 trial, significantly more patients were offered tamoxifen (p = 0.02), but acceptance rates did not change. Tamoxifen was offered to 91% of the ductal carcinoma in situ patients and accepted by 73% (67% overall). Lumpectomy was associated with significantly higher rates of being offered (p = 0.02) and accepting tamoxifen (p = 0.002) on univariate analysis. CONCLUSIONS: Factors associated with tamoxifen risks and benefits correlate poorly with the use of the drug. © 2005 by the American College of Surgeons.
Notes
10727515 (ISSN) Cited By: 0; Export Date: 25 May 2006; Source: Scopus CODEN: JACSE; DOI: 10.1016/j.jamcollsurg.2005.06.195 Language of Original Document: English Correspondence Address: Morrow, M.; Department of Surgical Oncology; Fox Chase Cancer Center; 333 Cottman Ave Philadelphia, PA 19111-2497, United States References: Tamoxifen for early breast cancer: An overview of the randomized trials (1998) Lancet, 351, pp. 1451-1467, Early Breast Cancer Trialists Collaborative Group; Olivotto, A., Coldman, A.J., Hislop, T.G., Compliance with practice guidelines for node-negative breast cancer (1997) J Clin Oncol, 15, pp. 216-222; Guadagnoli, E., Shapiro, C.L., Weeks, J.C., The quality of care for treatment of early stage breast carcinoma. Is it consistent with national guidelines (1998) Cancer, 83, pp. 302-309; Ernster, V.L., Barclay, J., Kerlikowske, K., Incidence of and treatment for ductal carcinoma in situ of the breast (1996) JAMA, 275, pp. 913-918; Miller, B.A., Feuer, E.J., Hankey, B.F., Recent incidence trends for breast cancer in women and the relevance of early detection: An update (1993) CA Cancer J Clin, 43, pp. 27-41; Morrow, M., Krontiras, H., Who should not receive chemotherapy? Data from American databases and trials (2001) J Natl Cancer Inst Monographs, 30, pp. 109-113; Fisher, B., Dignam, J., Wolmark, N., Lumpectomy and radiation therapy for the treatment of intraductal breast cancer: Findings from National Surgical Adjuvant Breast and Bowel Project B17 (1998) J Clin Oncol, 16, pp. 441-452; Rosen, P.P., Groshen, S., Kinne, D.W., Norton, L., Factors influencing prognosis of 767 T1N0M0/T2N0M0 patients with long term follow-up (1993) J Clin Oncol, 11, pp. 2090-2100; National Institutes of Health Consensus Development Conference Statement: Adjuvant therapy for breast cancer, November 1-3, 2000 (2001) J Natl Cancer Inst, 93, pp. 979-989; Goldhirsch, A., Glick, J.H., Gelbet, R.D., Meeting highlights: International consensus panel on the treatment of primary breast cancer (2001) J Clin Oncol, 19, pp. 3817-3827; Goldhirsch, A., Wood, W.C., Gelber, R.D., Meeting highlights: Updated international expert consensus on the primary therapy of early breast cancer (2003) J Clin Oncol, 21, pp. 1-9; Fisher, B., Costantino, J.P., Wickerham, D.L., Tamoxifen for prevention of breast cancer: Report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study (1998) J Natl Cancer Inst, 90, pp. 1371-1388; Tchou, J., Hou, N., Rademaker, A., Acceptance of tamoxifen chemprevention by physicians and women at risk (2004) Cancer, 100, pp. 1800-1806; Yen, T.W.F., Hunt, K.K., Mirza, N.Q., Physician recommendations regarding tamoxifen and patient utilization of tamoxifen after surgery for ductal carcinoma in situ (2004) Cancer, 100, pp. 942-949; Swain, S.M., Tamoxifen for patients with estrogen receptor negative breast cancer (2001) J Clin Oncol, 19 (15 SUPPL.), pp. 935-972; Swain, S.M., Wilson, J.W., Mamounas, E.P., Estrogen receptor status of primary breast cancer is predictive of estrogen receptor status of contralateral breast cancer (2004) J Natl Cancer Inst, 96, pp. 516-523; Allred, D.C., Bryant, J., Land, S., Estrogen receptor expression as a predictive marker of effectiveness of tamoxifen in the treatment of DCIS: Findings from NSABP protocol B-24 (2002) Br Ca Res Treat, 76 (1 SUPPL.), p. 36; Fisher, B., Costantino, J., Redmond, C., A randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen receptor positive tumors (1989) N Engl J Med, 320, pp. 479-484; Rakovitch, E., Franssen, E., Kim, J., A comparison of risk preception and psychological morbidity in women with ductal carcinoma in situ and early invasive breast cancer (2003) Breast Cancer Res Treat, 77, pp. 285-293; Demorgan, E., Redman, S., White, K.J., "well, have I got cancer or haven't I?" the psychological issues of women diagnosed with ductal carcinoma in situ (2002) Health Expressions, 5, pp. 310-312; Mariotto, A., Ferr, E.J., Harlan, L.C., Trends in use of adjuvant multi-agent chemotherapy and tamoxifen for breast cancer in the United States 1975-1999 (2002) J Natl Cancer Inst, 94, pp. 1626-1634; Harlan, L.C., Abrams, J., Warren, J.L., Adjuvant therapy for breast cancer: Practice patterns of community physicians (2002) J Clin Oncol, 20, pp. 1809-1817; Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: First results of the ATAC randomized trial (2002) Lancet, 359, pp. 2131-2139, ATAC (Arimidex, Tamoxifen alone or in Combination) Trialists' Group; Healey, E.A., Cook, E.F., Orav, J., Contralateral breast cancer: Clinical characteristics and impact on prognosis (1993) J Clin Oncol, 11, pp. 1545-1552.