Adjuvant tamoxifen reduces subsequent breast cancer in women with estrogen receptor-positive ductal carcinoma in situ: a study based on NSABP protocol B-24.
Citation: Journal of Clinical Oncology. 30(12):1268-73, 2012 Apr 20.PMID: 22393101Institution: Washington Cancer InstituteForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal Article | Research Support, N.I.H., Extramural | Research Support, Non-U.S. Gov'tSubject headings: *Breast Neoplasms/dt [Drug Therapy] | *Carcinoma in Situ/dt [Drug Therapy] | *Carcinoma, Intraductal, Noninfiltrating/dt [Drug Therapy] | *Neoplasm Recurrence, Local/pc [Prevention & Control] | *Receptors, Estrogen/de [Drug Effects] | *Tamoxifen/ad [Administration & Dosage] | Adult | Age Factors | Aged | Antineoplastic Agents, Hormonal/ad [Administration & Dosage] | Antineoplastic Agents, Hormonal/ae [Adverse Effects] | Breast Neoplasms/mo [Mortality] | Breast Neoplasms/pa [Pathology] | Breast Neoplasms/su [Surgery] | Carcinoma in Situ/mo [Mortality] | Carcinoma in Situ/pa [Pathology] | Carcinoma in Situ/su [Surgery] | Carcinoma, Intraductal, Noninfiltrating/mo [Mortality] | Carcinoma, Intraductal, Noninfiltrating/pa [Pathology] | Carcinoma, Intraductal, Noninfiltrating/su [Surgery] | Chemotherapy, Adjuvant | Disease-Free Survival | Dose-Response Relationship, Drug | Drug Administration Schedule | Female | Follow-Up Studies | Humans | Kaplan-Meier Estimate | Mastectomy, Segmental/mt [Methods] | Middle Aged | Neoplasm Invasiveness/pa [Pathology] | Neoplasm Recurrence, Local/mo [Mortality] | Neoplasm Staging | Receptors, Estrogen/an [Analysis] | Receptors, Progesterone/an [Analysis] | Receptors, Progesterone/de [Drug Effects] | Risk Assessment | Survival Analysis | Tamoxifen/ae [Adverse Effects] | United StatesYear: 2012Local holdings: Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2008ISSN:- 0732-183X
Item type | Current library | Collection | Call number | Status | Date due | Barcode |
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Journal Article | MedStar Authors Catalog | Article | 22393101 | Available | 22393101 |
Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2008
CONCLUSION: Patients in NSABP B-24 with ER-positive DCIS receiving adjuvant tamoxifen after standard therapy showed significant reductions in subsequent breast cancer. The use of adjuvant tamoxifen should be considered for patients with DCIS.
PATIENTS AND METHODS: Estrogen (ER) and progesterone receptors (PgR) were evaluated in 732 patients with DCIS (41% of original study population). An experienced central laboratory determined receptor status in all patient cases with available paraffin blocks (n = 449) by immunohistochemistry (IHC) using comprehensively validated assays. Results for additional patients (n = 283) determined by various methods (primarily IHC) were available from enrolling institutions. Combined results were evaluated for benefit of tamoxifen by receptor status at 10 years and overall follow-up (median, 14.5 years).
PURPOSE: The NSABP (National Surgical Adjuvant Breast and Bowel Project) B-24 study demonstrated significant benefit with adjuvant tamoxifen in patients with ductal carcinoma in situ (DCIS) after lumpectomy and radiation. Patients were enrolled without knowledge of hormone receptor status. The current study retrospectively evaluated the relationship between receptors and response to tamoxifen.
RESULTS: ER was positive in 76% of patients. Patients with ER-positive DCIS treated with tamoxifen (v placebo) showed significant decreases in subsequent breast cancer at 10 years (hazard ratio [HR], 0.49; P < .001) and overall follow-up (HR, 0.60; P = .003), which remained significant in multivariable analysis (overall HR, 0.64; P = .003). Results were similar, but less significant, when subsequent ipsilateral and contralateral, invasive and noninvasive, breast cancers were considered separately. No significant benefit was observed in ER-negative DCIS. PgR and either receptor were positive in 66% and 79% of patients, respectively, and in general, neither was more predictive than ER alone.
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