Breast cancer

26 August 2009

Tamoxifen may raise recurrence risk

New research suggests that the drug tamoxifen may raise the risk of getting a more aggressive cancer in the healthy breast by more than four times.


The drug tamoxifen is a tried-and-true way to lower the chances of developing the most common type of recurrence among breast cancer survivors, but new research suggests it raises the risk of getting a more aggressive cancer in the healthy breast by more than four times.

However, the finding is no reason to ditch the anti-cancer drug, as even the lead researcher emphasised.

"All treatments have risks and benefits," said study author Dr Christopher Li, an associate member of the Fred Hutchinson Cancer Research Centre in Seattle.

"We know that the benefits of tamoxifen treatment clearly outweigh the risks. This study adds another risk, but doesn't change the overall balance. If you consider the full balance, for most women the benefits are going to far outweigh the risks."

How the study was done
Li and his colleagues evaluated tamoxifen use among 1 103 breast cancer survivors from the Seattle and Puget Sound area. The women were diagnosed initially with ER-positive breast cancer, the more common and less aggressive form, between the ages of 40 and 70.

Of those women, 369 developed a second breast cancer. Nearly all of those who took the hormonal therapy after surgery or other treatment used tamoxifen for five or more years.

The researchers compared those who took tamoxifen with those who did not and found the drug, which blocks oestrogen (which helps tumours grow) reduced ER-positive second breast cancers but boosted the risk of ER-negative tumours, which are less common but more aggressive.

"When we looked at the different types of second cancers, tamoxifen only lowered the risk of the more common and less aggressive type of cancer, ER-positive," Li said.

What the results showed
"It lowered that by about 60%. But it increases the risk of developing ER-negative, the more aggressive cancer, by fourfold." The study is published online in the journal Cancer Research.

Exactly why the tamoxifen boosts the risk of ER-negative second cancers is not known, but Li said it could be that prolonged tamoxifen use provides "a competitive advantage for the growth of ER-negative breast cancer cells."

Other experts agreed that the study is no reason to give up on tamoxifen. "The thing we have to remember is tamoxifen saves lives," said Dr Victor Vogel, national vice president of research at the American Cancer Society.

"Even though the risk of ER-negative goes up, only with five years or more, the risk of ER-positive [second breast cancer] goes down," he said. "We shouldn't lose sight of that."

"I worry people are going to panic if they are taking this drug," said Dr Minetta Liu, director of translational breast cancer research at the Georgetown University Medical Centre, in Washington, DC But they should not, she said, because "it has helped a huge number of women." – (HealthDay News, August 2009)


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Ask the Expert

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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