Change search
ReferencesLink to record
Permanent link

Direct link
Time dependent effects of adjuvant tamoxifen therapy on cerebrovascular disease: results from a randomised trial
Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
Linköping University, Department of Clinical and Experimental Medicine, Oncology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
Department of Oncolog, Umea University Hospital, Sweden.
Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
Show others and affiliations
2011 (English)In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 104, no 6, 899-902 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Nature Publishing Group , 2011. Vol. 104, no 6, 899-902 p.
Keyword [en]
breast cancer, tamoxifen, adjuvant treatment, adverse events, cerebrovascular disease
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-67321DOI: 10.1038/bjc.2011.45ISI: 000288437500002OAI: oai:DiVA.org:liu-67321DiVA: diva2:409379
Available from: 2011-04-08 Created: 2011-04-08 Last updated: 2014-11-21Bibliographically approved
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 (print) (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

Open Access in DiVA

fulltext(269 kB)54 downloads
File information
File name FULLTEXT01.pdfFile size 269 kBChecksum SHA-512
a2eb34c22ed381d389325638ec8961d1f2db620b2204472e865dec8d84c79806b999bf153421c6250bd1de7f8787884b14129ba6b8ea64b2e567a36f5a65ad79
Type fulltextMimetype application/pdf

Other links

Publisher's full text

Search in DiVA

By author/editor
Rosell, JohanNordenskjöld, BoStål, OlleCarstensen, John
By organisation
OncologyFaculty of Health SciencesDepartment of Oncology UHLHealth and Society
In the same journal
British Journal of Cancer
Social Sciences

Search outside of DiVA

GoogleGoogle Scholar
Total: 54 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Altmetric score

Total: 156 hits
ReferencesLink to record
Permanent link

Direct link