Breast cancer

03 June 2013

Doubling time on Tamoxifen cuts odds for recurrence of breast cancer: study

10 years on Tamoxifen increased side effects, but survival gains may be worth it, researchers say.


When it comes to using the drug tamoxifen to prevent breast cancer's return, longer may be better for some patients, a new study finds.

Women combating oestrogen-sensitive breast tumours fared better when treated with 10 years of tamoxifen compared to those given the current standard of five years, researchers found.

However, longer tamoxifen regimens were associated with a greater risk for side effects from the cancer-suppressing drug, such as night sweats, hot flashes, blood clots, strokes and a heightened risk for cancer of the lining of the uterus (endometrial cancer).

Still, the investigation found that 10 years of treatment gave patients better protection against the recurrence of oestrogen receptor (ER)-positive breast cancers and/or death than did treatments offered for half the time.

Benefits of therapy outweigh any risks

Assessing the findings in conjunction with the results of another recently completed study called the ATLAS trial, the team concluded that the benefits of prolonged therapy still outweigh any risks.

The study was scheduled for presentation on Sunday in Chicago at the annual meeting of the American Society of Clinical Oncology (ASCO).

Five years of tamoxifen "is already an excellent treatment but we thought that longer treatment might be even better because women with ER-positive breast cancer can have recurrences long after treatment is completed," study lead author Richard Gray, professor of medical statistics at the University of Oxford in the United Kingdom, said in an ASCO news release.

"Until now, though, there have been doubts whether continuing tamoxifen beyond five years is worthwhile," he added. "This study and its international counterpart ATLAS confirm that there is definitely a survival benefit from longer tamoxifen treatment and many doctors will likely recommend continuing tamoxifen for an extra five years."

The research was funded by Cancer Research UK and the UK Medical Research Council. Findings presented at medical meetings are typically considered preliminary until published in a peer-reviewed journal.

The study involved nearly 5 000 British breast cancer patients, all of whom had already completed a five-year regimen of tamoxifen by the time they entered the study at some point between 1991 and 2005.

Woman assigned to continue with medication

In turn, half the women were randomly assigned to continue the medication for another five years, while half stopped the treatment altogether.

The result: no appreciable difference was found in death or breast cancer recurrence when assessing the impact of the sixth to ninth years of continued treatment.

However, when looking long-term - at the 10th year and beyond - the team found that the longer treatment option was having an impact. For example, breast cancer recurrence was lower among the 10-year group than the five-year group, at 16.7% versus 19.3%, respectively.

What's more, continuing treatment for double the usual period also reduced the overall risk of dying from breast cancer, the team noted.

"These results are therefore practice-changing for premenopausal women with hormone receptor-positive breast cancer and especially relevant for women who are at high risk of recurrence," Dr Sylvia Adams, an ASCO spokesperson and breast cancer expert, said in the ASCO news release.

More information

There's more on oestrogen and cancers at the U.S. National Cancer Institute.

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Breast cancer expert

Dr Gudgeon qualified in Birmingham, England, in 1968. She has more than 40 years experience in oncology, and in 1994 she founded her practice, Cape Breast Care, where she treats benign and malignant breast cancers. Dr Boeddinghaus obtained her qualification at UCT Medical School in 1994 and her MRCP in London in 1998. She has worked extensively in the field of oncology and has a special interest in the hormonal management of breast cancer. She now works with Dr Gudgeon at Cape Breast Care. Read more.

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